Basic Suturing Techniques

AANSA Inaugural Conference and AGM

Sat 29-8-15

Holding the needle

• Hold the needle 1/3 to 2/3 ratio in needle holder

Placing the suture

• Wrist extension ensures 90 degree placement of suture

Placing the suture cont.

• Perpendicular exit through skin on second side

• Pull needle through in curve of needle

Ensure wound eversion

Eversion cont.

Tying the knot

The first throw

Sliding the first knot

Adjustment of the knot

Limitations of superficial sutures

Buried absorbable suture with buried knot

Buried subdermal

Buried subdermal cont.

Buried suture and epidermal suture

Vertical Mattress Suture

Vertical Mattress Suture

• Used if skin eversion is required and not possible with simple sutures

• Leaves obvious cross hatching

• Remove early

Horizontal Mattress Suture

• Good eversion

• Useful in thick glaborous skin (feet and hand)

• More ischaemia of wound edges

Subcuticular Suture

• Interrupted or running

• Superficial Dermis

• Place all sutures at same level

• No Suture marks

• Absorbable or non absorbable

Half buried Horizontal Mattress Suture

• Less Strangulation of flap edges

• Leave Knots on one side of wound only (eg. On areola for nipple suturing)

Other Closure Techniques

• Over and Over suture

• Quick• Haemostatic• Useful on scalp• Beware ischaemia

Other Closure Techniques

• Skin staples– Quick

– Temporary use to approximate skin

– Use forceps to evert edges and prevent inversion

– Remove early to prevent skin marks

Other Closure Techniques

• Skin tapes– Approximate

wound edges

– Use dermal sutures to take tension & prevent wound inversion

Questions

THANK YOU