Suturing Skills 

This station is testing your suturing skills and knowledge of different techniques.

 

This page will discuss important knowledge around needle, suture and suture technique choice, however we recommend attendance on a Basic Surgical Skills course and regular suturing practice to obtain proficiency.

Equipment
  • Suture material
  • Needle holder
  • Scissors
  • Toothed forceps
  • Scissors
  • Sharps bin

 

Techniques
  • Interrupted - Most simple suture to use and suitable for almost all situations

 

  • Mattress: Used to evert the wound edges

    • Vertical:

      • Advantages – greater closure strength – better for poorly supported or mobile tissue, better distribution of tension

      • Disadvantages – scar formation, necrosis at edge

    • Horizontal:

      • Advantages – distributes tension across a wound better than interrupted

      • Disadvantages – increased risk of tissue hypoxia compared to other suture types

  • Subcuticular – aim to oppose edges

    • Advantages – continuous suture, spreads wound tension, no visible external sutures

    • Disadvantages - require little wound tension so need deep dermal sutures

  • Deep dermal  - support wound and eliminate dead space in wound

  • Drain stitch - there are many ways to do this, the video below shows a way which is easy to practice at home.

 
Handy Tips
  • Wash your hands, bare below elbow

  • Use the assistant if required

  • Make sure you use good basic surgical skills e.g. use tooth forceps to mount the needle, good spacing of sutures, handle sharps safely

  • Wear gloves unless states not too

  • Clear all sharps immediately

Knowledge

Needles

  • Round body

    • These separate tissues rather than cut, resulting in a leak-proof closure as tissues close tight around the suture. 

    • Example of ENT uses - suturing tonsillar fauces together

  • Cutting needle

    • Triangular "D" cross-section, have the apex curve on the inside. Needle cuts the front section of tissues only

    • Example of ENT use - skin closure

  • Reverse Cutting

    •  Triangular "D" cross-section, have the apex curve outside needle curvature. This lessens the risk of cutting out tissue. There is also increased needle strength and increased resistance to bending.

    • Example of ENT use - mucosal closure, pinnaplasty

 

Size and uses of different Sutures

  • 7/0 or smaller – microsurgery, ophthalmology

  • 6/0 – Face, blood vessles

  • 5/0 – Face, neck, blood vessels

  • 4/0 – Mucosa, neck, blood vessels, hands, limbs, tendons

  • 3/0 – Limbs, trunk, gut, blood vessels

  • 2/0 – Trunk, fascia, viscera, blood vessels

  • 0 or larger – abdominal wall closure, drain sites, arterial lines

 

Types of suture

An ideal suture would be easy to secure/tie, give little tissue reaction and maintain tensile strength for the period required to hold the tissues together whilst it heals.

 

Non-Absorbable Sutures

 

Timing of removal of sutures

Face: 3-4 days, Scalp: 5 days, Trunk: 7 days, Arm or leg: 7-10 days, Foot 10-14 days

Absorbable Sutures

  • Braided

 

  • Monofilament

Further Resources
Patel KA & Thomas WEG. Sutures, ligatures and staples. Surgery (Oxford) 2008; 26: 48-53. 
Basic Surgical Skills handbook (all years).

 
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