Suturing Techniques

The need for surgery can crop up at any time. Doctors may need to repair different kinds of wounds, for which they need a wide variety of apparatus and components. To repair wounds, doctors typically use a medical device known as a surgical suture, which assists in holding body tissues together; post an injury or a surgery. A suture typically involves a needle and an attached thread and is commonly confused with stitches, which is nothing but the technique doctors use to close a wound. Wounds are closed by using a wide variety of surgical sutures of varying shapes, sizes, and thread materials made up of absorbable and non-absorbable material. The doctor also determines the appropriate suturing techniques depending on the wound that has to be repaired. Here are some of the most common suturing techniques used by doctors. 

The simple subcutaneous suture technique

The most common suture technique used for wound closure is the simple subcutaneous suture technique. This technique is performed in order to release the tension from the surface of the wound, thus easing the healing of the skin. In this technique, the surgeon usually attempts to place bulky knots into the deeper parts of the wound. When this technique is used, the body’s reaction to the knot does not take place just under the skin, thus enabling the skin to heal without much disturbance. The simple subcutaneous suture technique can obtain optimal results when short-term or mid-term absorbable multi-filaments are used to suture a wound, depending on its severity.

Continuous subcutaneous suture technique

The second most commonly used suturing technique is the continuous subcutaneous technique. Often considered as an alternative to the simple subcutaneous technique, it is also considered an advantageous technique since it is more resistant than a simple suture. Furthermore, continuous sutures may be performed more rapidly than simple stitches. However, like most other sutures, there is the risk that a wound may split or burst open if the suture breaks. The continuous subcutaneous suture technique can obtain optimal results when short-term absorbable multi-filaments are used to suture a wound. If wounds are subjected to high-tension, the surgeon may also use mid-term absorbable multi-filaments or mid-term -term absorbable mono-filaments.

Continuous subcutaneous interlaced suture technique

Performed as a variation of the continuous subcutaneous suture, the interlaced suture technique provides extra resistance. It retains most of the tension, thus enabling surgeons to perform a tension-free skin suture. The interlaced suture also acts as an anti-slippage suture. In this suturing technique, threads provide higher friction at each passage, which in turn give a firmer hold during suturing. It also ensures that stitches will not loosen when the next passage is performed. Doctors typically use a mono-filament suture as they provide a smoother surface that enables them to pull after every passage to tighten the already sutured part. The continuous subcutaneous interlaced suture has high tensile strength which is extremely useful on wounds under high tension or in case of highly vascularised tissues, requiring additional haemostasis. This suturing technique can obtain optimal results when mid-term absorbable mono-filaments are used to suture a wound.

Simple skin suture technique

A suturing technique typically used for closing a wound, the simple skin suture is one in which the surgeon performs separated stitches, meant to hold the edges of the wound together. The surgeon takes great care to ensure that once the first knot is performed, it is positioned on one side, in such a way that it does not directly lie on the edge of the wound. Doing this ensures that the wound healing process remains undisturbed. Simple skin sutures are easy to place, and they provide excellent tensile strength. They are less likely to compromise the circulation of blood. That said; it takes a little more time to place these sutures. This technique can obtain optimal results when non-absorbable mono-filaments or mid-term absorbable mono-filaments are used to suture a wound.

Continuous skin suture technique

Also referred to as the “running suture”, the continuous skin suture technique is primarily used with tension-free wounds, in which deeper sutures are placed so as to minimise the wound tension. Doctors consider continuous skin sutures because they typically cause less scarring, as it involves the use of lesser knots. Much like continuous subcutaneous sutures, continuous skin sutures are also placed rapidly, but there is also the risk that the wound may burst open if this suture breaks. The continuous skin suturing technique is generally used for securing the perimeter of a split or a full-thickness skin graft. This suture technique can obtain best results when doctors use non-absorbable mono-filaments or mid-term absorbable mono-filaments for wound closure.

Continuous intra-cutaneous non-absorbable suture technique

The continuous intra-cutaneous non-absorbable suture is a technique preferred by patients who are concerned about the aesthetic results of their scars. The surgeon typically uses the continuous intra-cutaneous non-absorbable suturing technique only in the areas with minimal stress – for instance, in areas where the tension is eliminated with the help of deeper sutures. This suture essentially comprises of a non-absorbable mono-filament which runs within the skin. The doctor places strips over the wound upon completing the intra-cutaneous suture. As the skin heals and regains its strength to close the wound, the doctor removes this suture by pulling on either one of its ends. This suture also has a smooth surface, which ensures that it easily slides through the skin.

Continuous intra-cutaneous absorbable suture technique

Doctors also perform intra-cutaneous sutures with the help of absorbable sutures. The advantage of opting for this suturing technique is that it can be performed in one sitting, and the patient typically does not need to revisit the doctor to extract the suture. This is attributed to the fact that this type of suture is slowly degraded by the tissues. Once again, the surgeon places strips over the wound upon completing the continuous intra-cutaneous absorbable suture technique. Note that this technique is only used to suture wounds in areas where there is an absence of tension, at the skin level. In this technique, surgeons typically use mid-term absorbable mono-filaments to obtain the best results.

Mattress suture technique

The suturing technique used when wound edges are not close to each other, thus allowing tension-free healing is known as the mattress suture technique. Surgeons also use this technique in procedures to ensure the eversion of wounds and to minimise substantial wound tension. These sutures are predominantly used in areas in which the edges of the wound tend to invert, for instance, wounds on concave surfaces. The use of the mattress suture technique is usually limited to areas in which cosmetic results are essential. This suturing technique has two variants, i.e. horizontal and the vertical mattress suture techniques. The horizontal suture helps with minimising wound tension and closing dead spaces. It also facilitates wound edge eversion. The vertical suture, on the other hand, is regarded as one of the best suturing techniques that ensure wound eversion, while also reducing wound tension significantly. Horizontal and vertical suture technique can obtain optimum results when surgeons use non-absorbable mono-filaments for wound closure.

Corner sutures

There will be several incidents when the wound edges are not straight or parallel to each other. Sometimes, one may need to get stitches in an area where the edges are twisty or irregular. As such a corner pattern may be forming, and the surgeon may need to perform the corner suture technique to close or suture a wound surgically. Doctors take extra care to ensure that the corner is sutured correctly so that necrosis of the tissues can be avoided. They avoid performing simple stitches in such areas since it can increase the risk of necrosis. Instead, the use they intra-cutaneous suture which is knotted on the surface, on the outer side of the wound. The corner suture technique can obtain optimal results when non-absorbable mono-filaments are used to suture a wound, depending on its severity.

Surgical sutures we offer

Meril offers a wide range of sutures such as the MITSU polyglactin 910 sutures, the MITSU FST sutures, the MITSU C+ surgical sutures and the MITSU AB Anti bacterial sutures. Of these, the latter are used in most of the above mentioned suturing techniques such as the simple subcutaneous suture technique, the continuous subcutaneous suture technique, the continuous subcutaneous interlaced suture technique, the simple skin suture technique, the continuous skin suture technique and the continuous intra-cutaneous absorbable suture technique. The MITSU AB suture minimises the risk of suture-induced surgical site infections by obstructing the colonisation of pathogens. It is a mid-term absorbable, braided and synthetic suture made up of poly(glycolide-co-l-lactide) (90/10) and coated with the anti-bacterial Triclosan. This suture degrades by hydrolysis, while it assures reliable and predictable absorption.

The MITSU AB suture retains 75% knot tensile strength for up to 14 days, 50% knot tensile strength for up to 21 days and provides complete mass absorption within 56 to 70 days. It offers excellent knot security and minimises inflammatory reactions.

Final note: Suturing is one of the most common wound closure technique. Good suturing techniques are those that eliminate the dead space in subcutaneous tissues while minimising tension which causes the separation of the wound. The outcome of the good suture depends on several factors such as the suture material used and the systemic diseases one may be battling. Read on to know more about the different types of surgical sutures and their uses.