What is Suturing?
Suturing is a technique to bring tissue together to help the healing process of the lacerated tissue or surgical incision. Suturing is preferred by almost all surgeons as the technique of closing incisions but there are several different types of stitches that are used for the variety of wounds there are. Plastic surgeons would prefer a inter-cutaneous suture, while trauma surgeons would use staples or a basic instrument tie, and cardiothoracic surgeon would use a running whip stitch.
Video found at https://www.youtube.com/watch?v=TFwFMav_cpE
Instrument Ties
The basic instrument tie is used with basic lacerations and may leave the most scarring. It is performed using a needle driver, a curved suture needle and nylon or silk suture thread. The needle is pushed through the skin at a 90 degree angle and the needle should follow the curve until it surfaces on the other side. The thread is pulled through until there is about 3 inches left on the entry side of the laceration. The person suturing will then use the needle driver to grab the 3 inches and wrap the thread on exit side of the laceration twice, making a surgeon's knot. The person will then wrap it around the needle driver once more and pull the thread through again, and repeat these steps three times. The instrument suture should bisect the wound, and bisect those halves and so on.
Basic Running Stitch
The running stitch is similar to an instrument tie, but it is non interrupted. The suture is started at the end of the laceration, an instrument tie is placed. The thread starts under the skin, comes up, and goes over the next part of the skin, and continues in a spiral shape. At the end of the stitch, the suture is concluded with an instrument tie and is buried in the skin for a more aesthetic appearance.
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Mattress Sutures
The mattress suture is used to close wounds and laceration only. The advantages of a vertical or horizontal mattress suture is that it provides both deep and superficial closure for the wound. You are going to advance the needle on one side of the wound and then you are advance one more puncture about a half of a centimeter on the entry side of the wound. Now you are going to continue to the other side of the wound and puncture, pulling the thread out and repeating step 2. This is an interrupted suture and should be tied off each time.
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Taking Sutures Out
To take out sutures, simply bring the knot to one side of the laceration and cut down the middle of the suture making sure you are not bringing the know through the skin, repeat this for each stitch. Make sure you use sterile gloves, and dispose of the bio hazardous material as needed. Note that this is a clean procedure so make sure that all tools involved are sterile.
References
AAFP. (2008, October 15). Figure 3&4 [Diagram]. Retrieved from http://www.aafp.org/afp/2008/1015/p945.html
Duke University. (n.d.). Duke Suture Skills Course - Learn Suture Techniques [Video file]. Retrieved from https://www.youtube.com/watch?v=TFwFMav_cpE
FlyLib. (2007). 17-2 [Diagram]. Retrieved from http://flylib.com/books/en/2.569.1.25/1/
Duke University. (n.d.). Duke Suture Skills Course - Learn Suture Techniques [Video file]. Retrieved from https://www.youtube.com/watch?v=TFwFMav_cpE
FlyLib. (2007). 17-2 [Diagram]. Retrieved from http://flylib.com/books/en/2.569.1.25/1/