Suturing Techniques

Article Overview

Suturing is a fundamental technique in the field of surgery that is necessary to close wound edges and promote tissue healing. This technique is not merely a mechanical process but a critical factor in the wound healing, significantly impacting patient recovery. The primary purpose of sutures is to hold wound margins in proximity and foster the healing process during the critical period when the wound is most susceptible to disruption. The effectiveness of wound closure and subsequent healing is linked to several factors, including the volume and nature of the suture material, the specific closure technique utilized, and the degree of tension applied to the sutures.¹

When selecting the optimal suture material, surgeons look for a combination of characteristics that lead to improved wound healing outcomes. Desirable characteristics include maneuverability, knot security, good tensile strength, and the ability to adapt to wound swelling while returning to its original dimensions as edema subsides. Factors such as sterility maintenance, intraoperative visibility, and economic feasibility also play crucial roles. However, the reality is that no single suture type perfectly embodies this entire spectrum of ideal properties.² Therefore, surgeons must carefully choose the most appropriate suture material for each specific surgical situation. Furthermore, the selection of suturing techniques and materials is heavily influenced by the wound's specific characteristics, including its shape, depth, and the mechanical forces acting upon it.³

These crucial suturing concepts and techniques are now illustrated through a comprehensive video demonstration, in which a wide range of suturing methods and their applications are presented and explained. The video begins with an overview of common instruments found in a suturing kit. These typically include suture pads, scalpels, needle drivers, scissors, and forceps. Proper handling of these instruments is emphasized, particularly the correct grip for scissors and forceps. The importance of proper needle loading is highlighted, with the needle ideally held at a 45-degree angle and loaded two-thirds from its tip for optimal dexterity.

The simple interrupted stitch is demonstrated as a fundamental technique for closing superficial incisions.^4,5 This method involves passing the needle perpendicular to the skin, ensuring symmetry on both sides of the incision. A frequent mistake when performing simple interrupted sutures is excessive tightening. This can result in visible marks on the skin once post-surgery swelling develops. A potential solution to this issue involves utilizing a loop-style knot rather than the standard square configuration. However, it's worth noting that this technique has a significant drawback—it often leads to the formation of crisscrossed linear scarring, reminiscent of railway tracks.⁶

The running or continuous stitch, an extension of the simple interrupted technique, is then illustrated. This method is particularly useful for longer incisions, with emphasis placed on maintaining consistent spacing and depth throughout the closure.

Vertical and horizontal mattress sutures are applicable in situations where a greater wound eversion is needed.⁷ The horizontal mattress is described as involving full-thickness bites on both sides of the incision, with a characteristic horizontal orientation relative to the wound. One of the benefits of this strategy is how quickly it can be implemented. These techniques are particularly useful in scenarios such as fasciotomy closures, where significant tissue tension is present.

Two methods for closing laparoscopic port sites are demonstrated in the video: the U-stitch and the deep dermal stitch. The U-stitch is shown to remain within the dermal layer, traveling along the length of the incision. The deep dermal stitch, alternatively, is demonstrated as a deep-to-superficial, superficial-to-deep technique, with the knot buried in the subcutaneous tissue. These methods are crucial for minimizing scarring and reducing the risk of wound infection in laparoscopic procedures.

The running subcuticular stitch is presented as an advanced technique for achieving aesthetic closure without external sutures.⁸ The method begins with a deep dermal stitch and continues with a series of intradermal passages. The Aberdeen knot is demonstrated as a unique method for terminating this stitch, allowing for a secure closure without external knots.⁹

Proper wound closure techniques are essential for promoting healing, minimizing scarring, and reducing postoperative complications. By providing a detailed, step-by-step guide to various suturing methods, this video serves as an invaluable tool for surgical training programs and continuing medical education. The detailed explanation of each technique, coupled with practical demonstrations, provides a valuable resource for both beginner and experienced practitioners. By emphasizing proper technique, instrument handling, and tissue management, this demonstration contributes significantly to the development of essential surgical skills.