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SUTURE PATTERNS AND CLINICAL

APPLICATIONS or the sewing course for surgeons

Susanne Lauer

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Purpose

Provide strength during lag phase

Promote tissue appositionprimary wound healing (fast)

water-tight seal to hollow organs

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Classification

How performed (placed) Interrupted (single sutures)

Continuous (sutures linked)

How tissues are affected Appositional

Inverting

Everting

How much tissue suture spans Simple

Mattress

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Advantages and Disadvantages

Interrupted Continuous

1. If one fails, remainder

unaffected

1. Failure of one portion

-> failure of entire

suture line

2. More knot tying

-> more sx time

2. Quicker

3. More suture materialimplanted

3. Less suture material

4. More knots

-> more irritation

4. Less knots

-> less irritation

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Appositional Sutures

Allows healing of like tissue layers

More physiologic

Early strength (functional fibrin adhesions) Maintains lumen

Equal seal of hollow organs compared to

inverting and everting patterns

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Appositional Suture patterns

Simple Interrupted

Gambee

Interrupted Intradermal or Subcuticular Interrupted Cruciate or Cross Mattress

Simple Continuous

Continuous intradermal or subcuticular Ford Interlocking

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Simple Interrupted Gambee

Interrupted Subcuticular

Appositional Suture Patterns

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Interrupted Cruciate Simple Continuous

Continuous Intradermal


Ford Interlocking


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Inverting and Everting Patterns

Non physiologic healing

More scar tissue,

More reaction, due to microabscesses Inverting -> less peritoneal adhesions

As single layer, not stronger than other patterns

Compromises lumen size Good water-tight seal

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Inverting Suture Patterns

Lembert

Halsted

Cushing Connell

Parker Kerr

Purse String

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Interrupted Lembert Continuous


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Halsted

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Parker-Kerr


Purse

String

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Suture Pattern Terminology

Suturing or Sewing

Suture not Stitch

Bite = span of tissue that suture encompasses

on either side of incision Bite is often referred to for: Distance

Orientation in relation to incision Spacing

Placement order, technique

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Suture Pattern Terminology

Short end (tag) = end of suture

Long end (tag) = end with needle

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Knots

Weakest point of

suture

Each phase of knot= throw

Need at least 2

throws for knot

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Square Knot

Knot must be tied as

square to be secure

Need to interchange

the strand that goes

over the top (left over

right / right over left)

If same strand overthe top -> granny

knot

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Slip Knot

Can be created during

either throw of a square

knot

If knot not tied flat

Not secure

But, can be advantageous

when tension present

(needs additional secure

throws)

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Surgeons Knot

Indication: moderatetension across incision

First throw with two

passes, followed bysecond throw with asingle pass

Subsequent knots arestandard (single pass)

Do NOT use, if notneeded -> too muchirritationbulky!

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How many knots to be safe?

Interrupted sutures: 4 throws

Continuous sutures: 5 throws

Further increase in throws -> does not increase

strength

If knot weak -> increase diameter of suturematerial

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Knot placement

Standard -> superficial

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Knot placement

Buried knot

Indication:

Subcutaneous tissue

On deep surface

Knot not exposed

Interrupted

Continuous

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Suture Placement and Knot Tying

Suture placementHand placement In flat tissue planes

Large straight needlesNeedle holder placement Difficult access areas

Smaller needles

Knot tyingBy hand or using the needle holder

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Downloaded from: Small Animal Surgery, 3/e (on 22 February 2010 05:20 PM)

2007 Elsevier

Knot Tying with Needle Holder

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Mattress Sutures

Interrupted Vertical mattress

Interrupted horizontal mattress

Quilled Near and far

Stent

Continuous horizontal mattress Locking Loop

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Tension Suture Patterns

Interrupted

vertical

mattress

Interrupted

horizontal

mattress

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Tension Suture Patterns

Quilled Far to near

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Kessy, 3y, F, Rottweiler

Bred 71 d ago

1st litter

HBC 2y prior(pelvic fract.)

Greenish fluidfrom vulva 8hago

No pup yet

Strong contractions

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Kessy, 3y, F, Rottweiler

Abd radiographs:

7 pups, one fetus

in vaginal canal;malunion of

pelvic fractures

CBC, chemistryunremarkable

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Dystocia, Cesarian Section

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Dystocia, Cesarian Section

How to close ???

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Uterine closure

1-2layer

3-0, 4-0

absorbable

taper-point

Simple contin

+/- Cushingsor Lembert

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Abdominal closure

How to close ???

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Abdominal closure

External Rectussheath!!!!!!!

Absorbablesimple interruptedor continuous

(depending onexperience)

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Interrupted/Continuous Advantages ?

Interrupted

Tension precisely adjustable

Continuous Speed

More air & watertight seal

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Interrupted/Continuous Disadvantages?

Interrupted

More foreign material

Poor suture economy

Time consuming

Continuous

Suture breakage = Disaster

Less precision

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Subcutaneous Subcuticular

Deadspace and Approximation

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Burying the knot

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