Suturing Technique HW

Needle Holder Clamping Position

The needle holder should be clamped approximately 1/3 of the distance from the swaged end of the needle to the needle point.

Swaged Area

The part of the needle in which the suture enters the needle; it should never be clamped.

Peritoneum

A thin membrane that lines the abdominal cavity beneath the posterior fascia; it may not require suturing.

Fascia

The primary supportive soft tissue structure of the body; great care must be taken to close this layer securely.

Muscle (Abdominal Layer)

Tissue typically separated or retracted that does not tolerate suture material well; if needed, interrupted absorbable sutures are used.

Subcutaneous Layer

A layer that does not tolerate suture well, but may be sutured to prevent dead space, often using plain gut.

Subcuticular Layer

Tough connective tissue just beneath the skin and just above the subcutaneous layer; often closed with small-gauge absorbable sutures.

Skin (Suturing)

The outermost layer which may be closed with interrupted or continuous monofilament nonabsorbable sutures (polypropylene or nylon) or stainless-steel staples.

Primary Suture Line

The main suture that approximates the wound edges for first intention healing to occur.

Secondary Suture Line

Sutures placed to support and ease tension on the primary suture line, reinforcing the wound closure and obliterating dead space.

Interrupted Suturing Technique

A technique used to close tissues under tension (such as abdominal fascia and tendons) or infected tissues; it promotes greater strength along the wound.

Continuous Suturing Technique

A single strand of suture placed as a series of stitches often used to close long incisions; it is contraindicated in the presence of infection.

Blanket Stitch

Also known as a running and locking suture technique, which is an example of a continuous stitch.

Suture Cutting

Sutures should be cut close to the knots to prevent increased tissue inflammation and irritation caused by long ends.

Peritoneum Closure Suture

If the surgeon chooses to close this layer, a continuous $3-0$ absorbable suture is frequently utilized.

Fascia Suture Material

An interrupted, heavy-gauge, nonabsorbable suture is preferred, or polypropylene surgical mesh if the layer is weak.

Subcutaneous Suture Material

Plain gut is often preferred for closure of this layer to prevent dead space.

Subcuticular Suture Material

Small-gauge absorbable sutures are preferred because they do not need to be removed.