Suturing Techniques - The Leading Physicians of the World

Suturing Techniques
Suturing is a procedure that is used to close cutaneous wounds. The suturing techniques have remained the same for years but the suturing materials have changed. However, the primary goals of suturing have remained the same as listed below:
  •          Main aim is to close dead space
  •          Support and strengthen wounds until healing is complete
  •          Reduce the risks of infection and excessive bleeding
  •          Estimating the edges of the skin for a pleasing and functional result

Choosing the best suturing technique depends on the surgeon’s suturing skills.
Selection of a better suturing technique will depend on the following:
  •          Thickness of your skin
  •          Type and location of your wound
  •          Degree of tension
  •          Cosmetic results of choice

In this article, suturing techniques of various types of stitches are discussed. Sometimes more than one suture technique can be needed to close your wound completely. Suturing techniques selected to close a wound depends also on the surgeon’s personal choice and surgeons suturing skills. Below are some of the suturing techniques:

1.      Pulley suture
This is a suture that enables greater stretching of your wound edges. This technique is used when there is need for additional strength for the closed wound.

2.      Horizontal mattress suture
This is a suture technique applied for wounds under high tension to provide extra strength and wound eversion. It can sometimes be used as a stay stitch to help estimate wound edges which allows placement of subcuticular or simple interrupted stitches. Horizontal mattress stitches can be allowed to stay for a few days in case wound tension persists. If such sutures are left for more than 7 days, they may impose a risk of developing suture marks.

3.      Half-buried vertical mattress suture
This is a suture technique that is used for cosmetic purposes. It is mainly used in area of the face to prevent formation of large scar tissue

4.      Far-near near-far modified vertical mattress suture
This technique is a modification of vertical mattress suture technique that functions the same as pulley suture. Its main function is to expand a tissue to the desired size. This suture is also useful when closing a wound which is under high tension.

5.      Half-buried horizontal suture
This technique is also referred to as three-point corner stitch or tip stitch. It is primarily used positioning tips and corners of flaps, performing V-Y closures and M-plastics. Corner stitches are used to increase blood flow to flap tips to help improve aesthetic outcomes and reduce risks of tissue necrosis as well.

6.      Absorbable buried suture
These sutures are used as a part of layered closure wounds with either moderate or high tension. They provide support to the wound by reducing tension on wound edges. This allows better epidermal approximation of the wound. These sutures can also be used to get rid of dead space or as anchor sutures to fix an overlying tissue to the underlying structures.

7.      Buried horizontal mattress suture
This suturing technique is used to get rid of wound dead space. This is aimed to tension around the wounds or reduces the size of the defect.

8.      Dermal-subdermal suture
This is a suturing technique that is aimed to increase wound eversion. This suture is placed to make sure it is superficially away from the edge of the wound.

9.      Running horizontal mattress suture
This technique is mainly used for skin eversion. It is used in areas such as the neck where there is high tendency of tissue inversion. This technique is also useful since it prevents spread of facial scars. This technique forms flatter and smoother scars compared to running suture.

10.  Running subcutaneous suture
It is an alternative for buried dermal suture when it comes to deeper or large wounds requiring quick closure. This suture technique can result in suture breakage which leads to formation of dead space beneath the surface of the skin.

11.  Running subcuticular suture
This suture is used in areas with minimal tension and where dead space has been eliminated. It is mainly used also for cosmetic purposes. This suture can be used to estimate the edges of a wound but is not required to provide wound strength.

12.  Running subcutaneous corset plication stitch
This suture is used to close wound that are more than 4cm wide and under excess tension. It is used to create natural eversion and for better approximation of wound edge.

13.  Deep tip stitch
This suture is used for V-Y closures, M-plasty and W-plasty flaps to help increase wound eversion. It helps provide a longer support to the flap compared to the traditional corner stitch. This suture also improves the alignment of the flap tip.

14.  Modified half-buried horizontal mattress suture
This is a modified form of corner stitch which is used to equal eversion of the flap edges and help provide improved aesthetic outcomes. This suture can increase risks of tissue necrosis if tied so tightly.

Specific Suturing Materials
Suturing material can be classified in terms of their structure, origin and their absorbility. They include:

1.      Natural vs.synthetic sutures
Natural sutures are those sutures made from synthetic collagen or from collagen extracted from a mammal’s intestines. Synthetic sutures are made from artificial polymers.

2.      Absorbable vs. nonabsorbable sutures
Absorbable sutures are aimed to provide temporary wound support until the wound heals completely and can overcome normal stress. Absorption of such sutures occurs due to enzyme degradation of natural material or by hydrolysis of synthetic materials.
Nonabsorbable sutures are used to support the wound until it heals but are removed after 2 weeks since they cannot be dissolved by enzymes.

3.      Monofilament vs. multifilament sutures
Monofilament suturing materials are made from a single strand which is more resistant to harboring microorganisms. They have less resistance when passing through the tissues.
Multifilament sutures are composed of many filaments braided or twisted together. They high tensile strength and better flexibility and pliability compared to monofilaments.

Examples of suture materials
Both absorbable and nonabsorbable sutures can be made from either synthetic polymers or from natural materials. They include:
Absorbable natural sutures
Examples are:
  •         Chronic surgical gut
  •          Plain surgical gut
  •         Collagen
  •         Fast-absorbing surgical gut

Absorbable synthetic sutures
Examples are:
  •          V-loc
  •          Polysorb
  •          Polyglytone
  •          Polycaprolate
  •          Polyglecaprone
  •          Polydioxanone
  •          Polytrimethylene carbonate

Nonabsorbable natural sutures
Examples are:
  •          Surgical steel
  •          Surgical silk
  •          Surgical cotton

Nonabsorbable synthetic sutures
Examples are:
  •          Prolene (polypropylene)
  •          Nylon
  •          Surgipro II
  •          Polybutester (Novafil)
  • ·         Polyester fiber
  • ·         Coated polybutester (Vascufil)


Location: New York, NY, USA

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