SIMPLE INTERRUPED SUTURES

>Most commonly used suture >Start by inserting the needle perpendicular to the skin. Go through enough of subcutaneous tissue. >Exit through the opposite edge of the incision at the same angle. >Tie both ends together. >Caution: Tie the knot only sufficiently tight. Too tight a knot would cause tissue necrosis. Too loose would hamper the healing.

CONTINUOUS SUBCUTANEOUS SUTURE

>Useful to approximate the edges of deeper layers to reduce the dead space. >Starting from one end of the incision, first take bites on both edges subcutaneously. Tie a knot. >Burry the knot. But do not cut the needle end of the suture. >Take small bites one side and the other alternatively in a continuous manner. >At the end of the incision tie a knot between the loose end and the loop of the last bite. Cut the free ends close to the knot and burry it. >The superficial layer can be closed with simple interrupted sutures or continuous cutaneous suture.

DEEP BURRIED SUTURE

>It is most useful to reduce the dead space of deeper incisions. It approximates the tissues better. >That way it reduces the tension on the cutaneous sutures. >Take a backhanded bite of deeper layer of subcutaneous tissue >Exit out of relatively superficial part of the subcutaneous tissue. >Enter the superficial layer of subcutaneous tissue of the opposite edge. >Exit from the deeper layer of the subcutaneous tissue. >Pull the tissues close. >Tie the knot. Cut the loose ends close to the knot. >Burry the knot CONTINUOUS LOCKED SUTURE

>This is a variation of continuous suture. >It provides beeter strength to the wound. >Useful for incisions with moderate tension >Has the disadvantage of tissue necrosis in poorly vascularized areas or if the knots are too tight. >Just like continuous suture, first place a simple suture. Do not cut the needle end of the suture. >After each stitch is placed, as in continuous suture, the needle is passed through the loop of the preceding suture. Gentle torsion is made before the next loop is placed. >Final knot is made just like in continuous suture between the free end and the loop of the preceding suture.