Iris Hospital

Any surgical procedure requires the creation of a wound and then a subsequent closure by the repositioning and securing the surgical flaps by suturing to allow optimum healing. A suture is a strand or thread used for the approximation of tissues and also for ligation off blood vessels. Suturing is the act of sewing or bringing tissues or the flap edges together and holding them in apposition until normal tissue healing takes place. Placement of sutures helps the wound to withstand normal functional stresses and to resist opening of the wounds.

Suturing techniques:

1. Interrupted Suture-Sling Suture - The suture is passed through both the edges at an equal depth and distance from the incision, needle penetration should be 3mm from wound edges and the knot is tied. It is the most commonly used suture. Advantages of this technique are as follow
   • It is strong and can be used in areas of stress.
   • Successive sutures can be placed according to individual requirement
   • Each suture is placed independently and the loosening of one suture will not produce any loosening of the other.
   • A degree of eversion can be controlled.
   • If the wound becomes contaminated, infected or if there is a formation of hematoma, removal of a few sutures is possible that and provides a satisfactory treatment.
2. Continuous over and over suture - A simple interrupted suture is placed first and the needle is then reinserted in a continuous manner in such a way that the suture passes perpendicular to the incision line below and obliquely below. The suture is ended by passing a knot over the untightened end of the suture. It provides a rapid technique for closure and distributes the tension equally over the suture line.
3. Continuous locking suture - In this technique, locking is provided by withdrawing the suture through its own loop. The suture passes perpendicular to the incision line. The locking prevents excessive tightening of the suture as the wound closure progresses.
4. Mattress suture - These sutures can be horizontal or vertical. These are used for resisting a muscle pull, evert the wound edges and to adapt the tissue flaps tightly to the underlying structures.
   • The horizontal mattress suture gives a broad contact of the wound margins. In this suture, the needle is passed from one edge of the incision to another and then again from the latter edge to the first edge in a horizontal manner, after which a knot is tied. The distance of the needle penetration from incision line and the depth of needle penetration is the same for each entry point, but the horizontal distance of the points of penetration on the same side of the flap differs.
   • The vertical mattress suture is similar to the horizontal mattress, except that, all the factors remaining constant, the penetration depth varies. It is used for the closure of deep wounds.
5. Figure of eight suture - The figure of eight suture can be used for the closure of small gaping wounds like an extraction suture closure after removal of a tooth.
6. Subcuticular suture - The subcuticular layer of the tough connective tissue if sutured will aid in holding together skin edges in a close approximation when better cosmetic results are desired. Continuous short lateral stitches are taken beneath the epithelial layer of the skin. The ends of the suture come out at each end of the incision and are knotted together. This type of suturing leaves back a cosmetic scar.

Some common types of surgical knot tying used during a surgical procedure are

1. Square knot - It is also known as the standard knot or the Reef knot method. It is a special knotting technique in which the knots are securely tied. Four throws of the suture material are placed in position and the ends are cut long.

2. Surgeon’s knot - It is formed by two throws of the suture around the needle holder on the first tie and one throw in the opposite direction in the second tie.

3. Granny’s knot - It is also called as the slip knot technique. It is used when using silk, chromic catgut or the plain catgut suture material. It involves a tie in one direction followed by a second tie in the same direction and a third tie in the opposite direction to square the knot and hold it securely.

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