BASIC SUTURING 1:

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BASIC SUTURING 1

• Tim Brandys MD FRCSC

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Principles of Wound Closure

• 1.Equal Bites on each side of the wound
• 2.Distance between sutures distance suture is
  from wound edge
• 3.Apposition,Eversion (skin),or
  Inversion(bowel)of wound edges depends on tissues
  being closed

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Principles of Wound Closure

• 4.Follow curve of Needle,levering causes damage
• 5.Approximation not Strangulationavoid excessive
  stitches placed too close together,be careful of
  post-op swelling with running and running locking
  sutures.

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Principles of Wound Closure

• 6.Principle of Halving 1st suture placed
  centrally.Next suture placed halfway between end
  of wound and 1st suture.And so on.
• Avoids mismatch of wound edges with Dog Ear

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HEMOSTATIC SUTURES
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SUTURE LIGATURE (STICK TIE,TRANSFIXION SUTURE)

• PurposeSecure control of a vessel
• TechniqueSuture passes thru vessel to anchor the
  knot
• Uses 1. One chance to ligate vessel may retract
  ex mesentery,amputation,
• pelvis
• 2.Large Vessel

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FIGURE OF EIGHT

• Purpose Secure ligation of vessel surrounded by
  other tissue(not readily controlled by a
  hemostat)
• TechniqueTwo parallel simple running sutures in
  same direction
• Uses1. Any recessed vessel in other tissue
• 2. Lumbar vessels in the aorta

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Purse-String Suture

• Purpose To invert or secure an opening in a
  structure
• Technique Encircle an opening or tube with
  simple running sutures
• Uses 1.Secure and prevent leaks around a
  drain.
• 2. Secure Aorta cannulation catheter
• 3. Invaginate stump of the appendix

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WOUND CLOSURES

• Interrupted Closure A new knot every 1 or2
  stitches
• Advantages Less interference with vascular
  supply to wound edges
• M ore secure,if one breaks
  others will hold incision together
• Disadvantage Time consuming

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RUNNING/CONTINUOUS CLOSURE

• Definition Many stitches between knots
• Advantages Faster
• Temporary seal against fluid
  loss
• Tension distributed along
  entire
• suture line
• Disadvantages Too much tension makes
• entire suture line ischemic
• Integrity can be
  broken at
• any point

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INTERRUPTED SUTURES
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SIMPLE INTERRUPTED

• Definition Equal full thickness bites thru skin
  and subcutaneous layers

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Vertical Mattress

• Definition Far-Far
• Reverse,Near-Near
• Purpose Everts skin edges with precise
  approximation and little tension
• Uses Any setting where you want good approx.
• with no tissue ischemia ex. Amputation stump

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Horizontal Mattress

• Definition Simple interrupted ,but additional
  parallel bites are taken in
• reverse
• Purpose Everts skin edges in wounds under
  tension

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Running

• Simple(Baseball)
• Vertical
• Horizontal
• Subcuticular Running
• Horizontal in the intradermal level

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SUBCUTICULAR
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Agenda

• 1.Proper needle placement on the driver
• 2.Simple Interrupted,
• Vertical Mattress,Horizontal mattress
• 3.Running Subcuticular
• 4.Stick Tie
• 5.Purse String
• 6.Figure of Eight