Let’s keep on the suturing topic and talk technique!
Interrupted suture- most commonly used in ED to close percutaneous wound
- Wound edges must be everted
- Needle enters skin @ 90 degrees with the suture loop as wide as it is deep to the skin surface
- Try and get similar width and depth on both sides
- Placed close enough so you don’t have a gap in the wound edges (approx distance between sutures = distance from wound edge around .5-1 cm)
- For most traumatic Lacs we see start with a bite in the center suturing out (clean linear sharp cuts can start at the far edge but we dont usually see these
Dermal/buried suture- used to approximate dermis below the skin (reduces tension and closes deep tissue spaces making it easier to close percuteanously)
Absorbable sutures must be used and the knot (less than 3 ideally) buried so as not to inhibit healing. Avoid in highly contaminated wounds
Running suture: rapid percutaneous long wound closure ideal for long wounds with already goo edge approximation (distributes tension evenly along the length of the wound)
- Final bite made 90 degrees in direction of previous bite left as a loose loop to act as a free end for knot tying.
- Disadvantage is if the suture breaks the entire wound will open and you cannot remove just a few sutures at a time.
Vertical Mattress- good for wounds under tension or whose edges tend to invert
- Far-Far suture acts as a deep/dermal stitch and near-near stitch acts to evert edges
Horizontal Mattress- also serves to evert wound edges and distribute tension good for pulling wound edges over larger distances or to as an initial suture to anchor two wound edges
- Also good for holding fragile skin together
Corner stitch- used to approximate angled skin flaps (avoids needing to put in multiple sutures to hold a corner down leaving the tip intact).
sources: utdol.com; http://www.aafp.org/afp/2002/1215/p2231.html, Rich Wong and google of course!