Ch.15 - Sutures

Basic guidelines

Suture and skin must be dry

Correct suture selection must be selected

Do not be afraid of removing tissues when necessary

Be wary of feature distortion

General procedure to closing an incision

1. Tie off arteries and veins

2. Dry your incision (phenol)

3. Choose your suture

4. Anchor your ligature

5. Fill incison with some absorption material

6. Finish your suture

Suture technique

1. Grasp needly tightly

2. Enter the skin at 90-degree angle

3. Do not obstruct the path of the needle. Avoid pointing needle at yourself at any time.

4. Direction of suture will vary

5. Bites and distance between them should be evenly and reasonably spaced

Suture selection depends upon:

1. Size of area

2. Location

3. Ligature thickness (easier to hide a thinner ligature)

4. Needle gauge

Types of sutures

1. Baseball

2. Inversion

3. Whip (roll suture)

4. Lock

5. Intradermal (hidden)

6. Double intradermal

7. Basket weave

8. Purse string

9. N or Z suture

10. Bridge

Baseball Suture

Secure and easily executed. Can be waxed over and most commonly used

Inversion (worm)

Security and utility. Easier to wax over. The edges are drawn inward or inverted.

Creates parallel ligature lines.

Needle should go parallel to the incision

Whip (Roll) suture

Simplest of all to execute

Best for long incisions and used only for temporary closure of tissue on an autopsy Y incision or a tissue donor.

Can be used for post embalming for long term closure.

Lock Stitch

1. Should not be selected in instances when the areas sutured is to be seen because it creates a ridge

2. Similar to whip stitch

3. Implied to be leak proof

Intradermal (Hidden) Suture

1. Must be aware of how thick a person's skin is

2. Must be aware of the thickness of the ligature used

3. Option to use this suture alongside glue

   Starts by anchoring it inside the incision

Double intradermal suture

Variation of intradermal suture.

Use a needle at both ends, alternating sides like lacing a shoe.

Basket Weave Suture

1. Used for anchoring wax

2. Used when edges of an incision or large ulcerations need to be secured but tightening would cause deformity on the surface of the face

N or Z suture

1. Final a spot close to the inferior and anatomical right of the opening, enter the tissue. Do not tie a knot.

2. Exit tissue in a spot superior to entry point and superior to the opening and then exit the tissue with your needle. Creates the first leg of the N

3. While still outside the tissue cross ligature over the opening to a point inferior to the opening

4. Enter the tissue at point in step 3

5. Repeat step 2 on anatomical left side of the opening

6. Tie the two ends of ligature together