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Suturing techniques

Different types of suture with videos. To learn the basics of suturing prior to trying these out click here.

 

Simple Interrupted Suture

  • Most simple suture to use and suitable for almost all situations
  • Needle is inserted in one side of the wound and out through the wound itself
  • Suture should extend through the full depth of the dermis
  • Needle re-inserted at the same level in the opposite side of the wound and emerges out of the skin the same distance from the wound edge as the insertion
  • Sutures should be placed approximately 2-5 mm from the wound edge and 5mm apart (this may vary depending on the size of the wound and location)
  • Use the forceps or a finger to evert the wound edges
  • Try to suture from the more mobile edge to the more fixed edge
  • Knots should be placed on either side of the wound edge and can be used to subtly adjust the edges to lie together

 

Simple Interrupted Suture

 

Vertical Mattress Suture

  • Promotes eversion of the wound edges
  • Useful for poorly supported or mobile skin
  • Needle is inserted as per the simple interrupted suture approximately 5mm from the wound edge and brought out the opposite side in the same way
  • Needle is then reinserted closer to the wound edge on the emergent side (approximately 1-3mm) and a shallow bite is taken back across the wound from the emergent side to the original side, coming out of the skin closer to the wound edge than the original insertion point (‘Far Far Near Near’)
  • The knot is then tied on the original insertion side

 


Vertical Mattress Suture

 

Horizontal Mattress Suture

  • Distributes tension across a wound more than the simple interrupted suture
  • Useful suture in the palm and other glabrous areas as well as wounds under tension
  • Increased risk of tissue hypoxia compared to other suture types
  • Needle is inserted as per the simple interrupted suture and brought out the opposite side in the same way
  • Needle is then re-inserted adjacent to the emergence point on the far side of the wound and brought out on the near side (i.e. like 2 simple interrupted sutures placed next to each other but traversing the wound in opposite directions; the path of the thread forms a rectangle
  • The knot is tied on the original side of the wound

 


Horizontal Mattress Suture

 

Subcuticular Suture

  • Continuous suture which spreads wound tension
  • No marks on skin surface as suture is placed within the superficial dermis
  • Requires little wound tension therefore deep dermal sutures are essential
  • Knots can be tied at the start and the end of the suture or can be left without knots- the purpose of this suture is to oppose the wound edges, not to provide support as these wounds should be under minimal tension
  • Needle is inserted approximately 1cm from one end of the wound and the needle brought out within the superficial dermis at the apex of the wound
    • A knot can be tied at this point within the wound/outside the wound, or the suture can be continued as below and any knots placed at the end
  • Needle is then inserted into the dermis on one side of the wound at the same level and brought out at the same level further along the wound i.e. a horizontal bite of the dermis
  • Needle is then inserted into the superficial dermis at the same level on the opposite side at the same point in the wound as the emergence point from the previous bite and brought out at the same level (again taking a horizontal bite of dermis)
    • This should be repeated the full length of the wound, taking even horizontal bites
  • At the end of the wound the needle should be inserted into the superficial dermis at the apex and brought out approximately 1cm from the wound edge
    • The suture will look like a ladder across the wound with no emergence through the skin except at the start and end
  • Knots can be tied at each end (tie the suture to itself) or the ends left exposed and secured with steri-strips
  • Skin glue or steri-strips can be used on top of the wound for further wound protection

 

Subcuticular Suturing

 

Common mistakes in subcuticular Suturing

 

Dermal Buried (Deep Dermal) Suture

  • Used to provide support to wounds and eliminate dead space in the wound
  • Needle is inserted into the wound beneath the dermis and brought out in the dermis, again into the wound
  • Needle is then inserted into the dermis on the opposite side and brought out into the wound at the same level as the original insertion
  • Knot is then tied within the wound and buried beneath the skin
  • The suture should be cut flush to the knot to ensure the ends do not protrude up out of the wound

 

Dermal Buried (Deep Dermal) Suture

  • There are many, many other suture techniques, try to see as many as possible during surgical attachments/jobs to become familiar with a variety of techniques

 

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