FLORABELLE A.

ANTONIO NOVEMBER 24, 2009

NCM 102a 8-C

TYPES OF WOUND SUTURING

1.Simple interrupted sutures: most versatile suture technique and are good
for
realigning irregular wound edges and stellate lacerations with more meticulous
approximation of the wound edges. An advantage is that only the involved
sutures need to be removed in case of infection. Wound integrity is greater and
the risk of premature separation (dehiscence) is less because the wound is held
together with multiple individual suture loops.

2.Continuous running sutures: quick, easy and may save time in the ED
because only two knots are needed as each end of the laceration rather than
individual knots for each interrupted suture loop. Continuous running sutures are
best when repairing linear wounds. A break in the a suture may ruin the whole
repair and cause permanent marks if placed too tightly. This type of suture is
often used where hemostasis is important such as vagina and scalp, where
locking the running suture aids in hemostasis. Another advantage is that it
accommodates to the developing edema of the wound edge during healing.
Two different patterns are used: Needle pathway is 900 to the wound edge
and results in a visible suture that crosses the wound edge at 450 angle. In the
other pattern the needle pathway is 450 angle to the wound edges, so that the
visible suture is at a 900 angle to the wound edges. In either case the provider
start the continuous suture closure at the corner of the wound that is farthest
away and suturing progresses toward the provider, rather than away.

3.Dermal (subcuticular) sutures: either continuous or interrupted may be

necessary prior to skin closure to reduce tension and gaping.Interrupted dermal
sutures are started by entering the skin near the base and exiting just beneath
the dermal epidermal junction.

Continuous dermal sutures are useful in wounds subjected to strong skin

tensions, patients prone to keloid formation, children frightened by suture
removal and those individuals unable to contact health professional for suture
removal. Absorbable synthetic braided or monofilament sutures are ideally suited
because they do not have to be removed. Continuous dermal sutures can be used
by themselves when percutaneous sutures might cause cosmetic problems. They
are ideal for linear facial lacerations, where sutures placed below the surface
minimize scaring.

4.Vertical mattress suture: allow for precise edge to edge alignment and are
especially good to match thick to thin skin. This suture enhances skin edge
eversion and avoids the tendency for inversion common with deep nonlinear
lacerations.

5.Horizontal mattress suture: faster and better at eversion than vertical

mattress. The repair may look poor early on, but with good eversion, the scar will
have a better cosmetic effect in 2-3 months. This suturing technique may be
 faster because it covers more linear distance. It is especially useful in areas of
increased tension such as fascia, joints, and callused skin.

6.Horizontal have buried sutures: good for repairing flaps and triangular
wounds. It minimizes tissue tension so it doesn’t strangulate the interposed
tissue. Similar to vertical mattress sutures, horizontal half buried sutures are also
useful to approximate thick to thin edges.

7.Purse string suture: useful at re-approximating multiple flap tips and corner
wounds back together. This technique is used in these areas in order to preserve
the blood supply and minimize tissue destruction at the tips of skin edges.

8.Dog ear maneuver: technique used to handle excess tissue at one end of the
wound. Basically the wound is extended from the apex toward the long side in
the form of a hockey stick. Then the triangular piece of excess skin is removed
and the skin edges are sewn together.

TYPES OF WOUND SUTURE

1. Absorbable suture is used in mucosal areas such as the oral cavity and
tongue and disintegrates by one of two methods: enzymatic breakdown of organic
material (e.g., surgical gut- plain or chromic) or by hydrolysis of synthetic material
(e.g., polyglactin 910 Vicryl).

2.Non-absorbable suture is made of silk, stainless, nylon, polypropylene, or

polyester fiber. They can be further broken down into monofilament or multi
filament. Monofilament passes through tissue more easily than braided suture,
though it has less tensile strength. A multifilament suture has better flexibility, yet
it may harbor organisms more easily within the braid.

Removing Stitches Introduction

Among the many methods for closing wounds of the skin, stitching, or suturing, is
the most common form of repairing a wound. Other methods include surgical staples,
skin closure tapes, and adhesives.

Stitches (also called sutures) are used to close cuts and wounds in skin. They can
be used in nearly every part of the body, internally and externally. Doctors literally
"sew" the skin together with individual sutures and tie a secure knot. Stitches then allow
the skin to heal naturally when it otherwise may not come together.
If you've received stitches, you will be given instructions for taking care of your stitches
and wound.

1.Keep wound clean and dry for the first 24 hours.

2.Bathing is allowed after 48 hours.
3.Bandages can safely be removed from the wound after 48 hours, unless the wound
continues to bleed or has a discharge. If bandages are kept in place and get wet, the
wet bandage should be replaced with a clean dry bandage.
 4.An antibiotic ointment (brand names are Polysporin or Neosporin, for example)
should be used after the wound is cleaned.
5.Notify your doctor if a suture becomes loosened or breaks.
6.Return when scheduled to have your stitches removed.
*Different parts of the body require suture removal at varying times. Common periods
of time for removal are these:
○ Face - 3-5 days
○ Scalp - 7-10 days
○ Trunk - 7-10 days
○ Arms and legs - 10-14 days
○ Joints - 14 days
Sutures may be taken out all at one visit, or sometimes, they may be taken out over a
period of days if the wound requires it.
STEPS IN REMOVAL OF WOUND SUTURE
Removing stitches (sutures)
1.The wound is cleaned with an antiseptic to remove encrusted blood and loosened scar
tissue.
2.Sterile forceps (tongs or pincers) are used to pick up the knot of each suture, and then
the surgical scissors or a small knife blade is used to cut the suture. Forceps are used
again to remove the loosened suture and pull the thread from the skin.
3.These relatively painless steps are continued until the sutures have all been removed.
You may feel a tug or slight pull as a stitch is removed.
4.The wound is cleansed again.
5.Adhesive strips are often placed over the wound to allow the wound to continue
strengthening.
After the Procedure
1.Wound care after suture removal is just as important as it was prior to removal of the
stitches. Take good care of your wound so it will heal and not scar.

2.Keep adhesive strips on the wound for about 5 days. Then soak them for removal. Do
not peel them off.
3.Continue to keep the wound clean and dry.
4.Skin regains tensile strength slowly. At the time of suture removal, the wound has only
regained about 5-10% of its strength. Therefore, protect the wound from injury during
the next month.
5.Injured tissue also requires additional protection from sun's damaging ultraviolet rays
for the next several months. The use of sunscreen during this period of healing is well
advised for those areas that are exposed.
6.The use of vitamin E topically has also been suggested to be helpful in the healing
process of the damaged skin. This should only be considered once the skin edges are
healed and are closed together.
 When to Seek Medical Care
If the following signs of infection are present, call the doctor.

Redness
Increasing pain
Swelling
Fever
Red streaks progressing up an arm or leg
Material coming from out of the wound
If the wound reopens and bleeding occurs