Needle construction o The needle has 3 sections.

The point is the sharpest portion and is used to penetrate the tissue. The body represents the mid portion of the needle. The swage is the thickest portion of the needle and the portion to which the suture material is attached. o In cutaneous surgery, 2 main types of needles are used: cutting and reverse cutting. Both needles have a triangular body. A cutting needle has a sharp edge on the inner curve of the needle that is directed toward the wound edge. A reverse cutting needle has a sharp edge on the outer curve of the needle that is directed away from the wound edge, which reduces the risk of the suture pulling through the tissue. For this reason, the reverse cutting needle is used more often than the cutting needle in cutaneous surgery (see image below).

Surgical needles which form 3/8th of a circle, in different sizes

Surgical needles which are semicircular, in different sizes.

Running, or Continuous Stitch The "Running" stitch is made with one continuous length of suture material. Used to close tissue layers which require close approximation, such as the peritoneum. May also be used in skin or blood vessels. The advantages of the running stitch are speed of execution, and accommodation of edema during the wound healing process. However, there is a greater potential for malapproximation of wound edges with the running stitch than with the interrupted stitch. Interrupted Stitch Each stitch is tied separately. May be used in skin or underlying tissue layers. More exact approximation of wound edges can be achieved with this technique than with the running stitch

Purse String A continuous stitch paralleling the edges of a circular wound. The wound edges are inverted when tied. Commonly used to close circular wounds, such as hernia or an appendiceal stump.

Smead-Jones/Far-and-Near A double loop technique alternating far and near stitches, and possessing greater mechanical strength than continuous or simple interrupted sutures. Commonly used for approximating fascial edges, especially for patients at risk for fascial disruption or infection.

Continuous Locking, or Blanket Stitch A self-locking running stitch used primarily for approximating skin edges.

Mattress Suture A double stitch that is made parallel (horizontal mattress) or perpendicular (vertical mattress) to the wound edge. Chief advantage of this technique is strength of closure; each stitch penetrates each side of the wound twice, and is inserted deep into the tissue.

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