Week 9 - suture patterns

What are the three classifications for pulling skin together?

• Opposing

• Everting

• Inverting

Opposing

The suture bring the tissue together end on end

What are opposing sutures good for?

The ideal suture for normal stitches

Everting

The suture tend to turn the edges outwards

What are everting sutures good for?

Helps with stability if the wound won’t be still and high tension is required

Inverting

The sutures tend to turn the edge inwards

What are inverting sutures good for?

Used for lumen of the intestine to reduce the rusk of adhering other structures in abdomen

How is the skin pulled together here?

Opposing

How is the skin pulled together here?

Everting

How is the skin pulled together here?

Inverting

What is the ideal stitch length?

1cm

What is the ideal stitch spacing?

0.5cm

What is the ideal stitch depth?

0.5cm

Where should a knot be placed?

All knots on the same on the inferior side

What is important about putting the knots on the inferior side

They’re place where gravity would take it

What is the basic knot used for suturing?

Square knot

What is better than a square knot

Surgeons knot

What’s a square knot?

A two-throw knot tied in opposite directions to create a stable, non-slipping closure.

What is a surgeons knot?

A double first throw followed up to 5 single throws

What are the 3 main components of a surgical knot?

• Loop

• Knot

• Ears

What is the loop?

The part of the suture material within the opposed or ligated tissue

What is the knot?

Composed of a number of throws - each throw being the linking of two strands of material around each other

What are the ears?

The cut end of the suture which prevents the knot coming untied

What knot is this?

Surgeons

What knot is this?

Square

What are the 8 surgical patterns?

• Simple interrupted

• Simple continuous

• Vertical mattress

• Horizontal mattress

• Ford interlocking

• Cruciate suture

• Purse string suture

• Subcuticular suture

Simple interrupted

• A interrupted suture pattern

• Holds the wound edges in opposition

What is a con of Simple interrupted?

• Time consuming

What is a pro of Simple interrupted?

If an individual suture falls the integrity of the suture line is maintained

Simple continuous

• A continuous suture pattern with one knot at either end

• Holds the wound edges in opposition

What is a pro of Simple continuous

Quick and simple to place/remove

What is a con of Simple continuous

If one knot/part of the suture line fails wound support across the whole suture line will be compromised

Vertical mattress

• An interrupted suture pattern

• Wound edges have a tendency to evert

What is a pro of Vertical mattress

• Effective for use in skin under tension

What is a con of Vertical mattress

• Can be time consuming to place/remove

• If an individual suture fails the integrity of the suture line is maintained

Horizontal mattress

• Can be continuous or interrupted

• Wound edges have a tendency to evert

Ford interlocking

• A continuous suture pattern with one knot at either end

• The interlocking suture helps to hold the wound edges in opposition

What is a pro of Ford interlocking

Quick to place/remove

What is a con of Ford interlocking

• More time consuming than a simple continuous

• The one knot/part of the suture line fails wound support across the whole suture line will be compromised

Cruciate suture

• An interrupted suture pattern

• Holds the wound edges in opposition

What is a pro of Cruciate suture

• Effective for closing wounds that will be under tension due to a skin deficit e.g. when a large skin margin has been taken when removing a mast cell tumour

What is a con of Cruciate suture

• Time consuming to place/remove

• If an individual suture fails the integrity of the suture line is maintained

Purse string suture

A continuous suture pattern

What is a pro of Purse string suture

• Quick to place/remove

• Use to tie off hollow organs or to close orifices to facilitate surgery e.g. to temporarily close the anus to allow for surgery in the anal region

Subcuticular suture

• Can be continuous or interrupted

• No part of the suture is visible on the skin surface

What are 9 rules of suturing?

• Handle tissue gently

• Minimal handling of suture material

• Use correct needle size

• Correct use of needle holders

• Even tension of each suture

• Sutures should always be placed at least 5mm from the wound edge and placed squarely across the wound

• Opposition without crushing

• The wound should never be gapping or overlapping