Quality Suture Techniques - Medical Students Need to Know and Practice

There are several suture techniques that can be used to close wounds. If you are a medical student, learning the common quality suture techniques is the first step to becoming a professional surgeon.

Preparation

1. Suture tools

• needle holder
• suture scissors
• toothed tissue forceps(skin hook)
• appropriate suture material, eg suture practice pad

Ultrassist suture kit provides all tools you need to practice suture techniques.

2. Basic suture steps

Grip: 

The needle holder should be held by the handgrip, which allows for better wrist mobility. And we should grasp the needle between 1/3 and 1/2 of the distance between the suture attachment and the needle tip.

Knot tying: 

The long end of the suture is wrapped twice around the tip of the closed needle holder. Then grasp the short end of the suture with the needle holder. Gently tight the first double knot. And then add two or three single throws in a similar way to secure the knot. Please note each throw is pulled in the opposite direction across the wound edge.

Suture removal:

• While removing sutures, one tail of the suture should be grasped with forceps and pulled gently towards one side of the wound, in order to elevate the knot.
• The opposite side of the suture should be cut immediately with stitch-cutters or suture scissors under the knot.
• Then the suture can be pulled out of the tissue by pulling it towards the opposite side of the wound.

Quality Suture Techniques/Methods

1. Simple interrupted suture

Take skin hooks or toothed forceps to stabilize the wound edge, and enter the suture needle vertically three to five millimeters from the wound edge. Knot and repeat.

Advantages:

• It is the most commonly used technique preferred in urgent situations.
• A greater version of the wound edge produces a thinner, less visible scar.
• It is easy to remove.

2. Continous suture

The suture technique is the same as the simple interrupted method at first. And then the suture is brought across the cut diagonally, and let the needle insert vertically again. Lastly, form a loop at the end and pass through the needle to tie the suture.

Advantages: Much faster than the simple interrupted method.

Disadvantages: Affect the blood supply of suturing area.

3. Horizontal mattress suture

The needle was entered between 5 and 10 mm from the wound edge, passed through the wound, and exited on the opposite side. Then the needle was reintroduced between 3 and 5 mm from the exit point (on the same side) and repeated.

Advantages: Provide necessary tension for large wound closure

Disadvantages: A risk of strangulation of the dermal blood supply and subsequent edge necrosis

4. Vertical mattress suture

Insert the needle 5 to 10 mm from the wound edge, ensuring a deep volume of tissue is obtained. Then exit the skin on the other side, reverse the needle position and re-enter the skin 1 to 3 mm from one side, then bite deep into the tissue again while repeating to one side. Secure with a knot at the end.

Advantages: 

• Better wound edge eversion than horizontal mattress sutures.
• Minimize dead space.

5. Buried suture

• Evert the edge of the wound with a skin hook.
• Enter the needle into the subcutaneous tissue using absorbable sutures.
• Needle exit through the dermal tissue on the same side.
• Reenter the needle through the dermic on the other side of the wound.
• Needle exit through the subcutaneous tissue.
• Tie a deep knot and ensure it has a short end.
• Repeat for the next stitch.

Advantages:

• Suturing in the dermis layer of the skin to close dead space.
• Extended support during healing and an improved cosmetic result.

To obtain the best results, it is important to have a good-quality instrument first. Fortunately, now there are various suture pads or suture kits on the market. Choose the right suture kit, then you can practice suture techniques at home or at school, or anywhere you will.