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

    vertical mattress suture

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

    Horizontal mattress

Corner stitch– used to approximate angled skin flaps (avoids needing to put in multiple sutures to hold a corner down leaving the tip intact).

Corner stitch

sources: utdol.com; http://www.aafp.org/afp/2002/1215/p2231.html, Rich Wong and google of course!