{"id":97,"date":"2015-12-05T21:47:03","date_gmt":"2015-12-05T21:47:03","guid":{"rendered":"http:\/\/brooksidepress.org\/surgery\/?page_id=97"},"modified":"2023-08-20T20:43:11","modified_gmt":"2023-08-20T20:43:11","slug":"2-7-advanced-suturing-techniques","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/surgery\/?page_id=97","title":{"rendered":"2-7. ADVANCED SUTURING TECHNIQUES"},"content":{"rendered":"

a. Running Suture<\/strong>. A running suture (figure 2-9) is similar to the simple suture\u00a0in technique. The difference is that the suturing material is not cut and tied with each\u00a0succeeding stitch.<\/p>\n

Multiple loops are made, starting at one end of the laceration and\u00a0working toward the other end of the laceration. For the final loop, enter the skin just\u00a0beside the entry point of the preceding stitch. After all the loops are in place, adjust the\u00a0tension along the repair and tie the suture to itself.<\/p>\n

<\/a>
Figure 2-9. The running suture.<\/figcaption><\/figure>\n

(1) Advantages. Among the advantages of the running suture are that\u00a0these sutures are inserted fast and are easy to remove. Also, the cosmetic appearance\u00a0is comparable to that of interrupted sutures.<\/p>\n

(2) Disadvantages. One of the disadvantages to the running suture is that a\u00a0break anywhere along the suture can cause the entire suture line to unravel. Also, if a\u00a0mistake is made, the suture must be cut, the loop removed, and the previous suture\u00a0stitch must be knotted.<\/p>\n

b. Locked Running Suture<\/strong>. The locked running suture (figure 2-10) is similar\u00a0to the running suture. This suture, however, passes through the preceding loop before\u00a0reentering the skin.<\/p>\n

(1) Advantages. The locked running suture is useful in the rare situations\u00a0where the wound edges have to be pulled together under tension to control bleeding.\u00a0The sutures are secure in that they are locked into preceding loops.<\/p>\n

(2) Disadvantages. Inserting the locked running sutures take more time.\u00a0Also, tissue may be strangled if the sutures are not inserted carefully.<\/p>\n

<\/a>
Figure 2-10. The locked running suture.<\/figcaption><\/figure>\n

c. Vertical Mattress Suture<\/strong>. The vertical mattress suture (figure 2-11) involves\u00a0placing a double line of suture material across the wound. The skin is entered and\u00a0exited twice, instead of only once which is normal with simple sutures. The result is that\u00a0two lines of suture lie one above the other.<\/p>\n

(1) Technique. Begin as you would for a simple suture. Enter and exit the\u00a0wound, however, a generous distance from the wound edge. Then, reenter the skin\u00a0about one to two millimeters from the wound edge. Tie the suture normally.<\/p>\n

<\/a>
Figure 2-11. The vertical mattress suture<\/figcaption><\/figure>\n

(2) Advantages. The vertical mattress suture ensures wound edge\u00a0eversion. This type of suture is useful in areas where the wound edges have a\u00a0tendency to invert.<\/p>\n

(3) Disadvantages. There are twice as many suture marks as with simple\u00a0sutures. The reason is that most vertical mattress sutures require four points of skin\u00a0entry and exit.<\/p>\n

d. Horizontal Mattress Suture<\/strong>. In this type of suture (figure 2-12), the two lines\u00a0of suture lie parallel to one another in a horizontal plane. The needle enters on the far\u00a0side of the wound and exits on the near side. Then, the pattern is reversed; the needle\u00a0enters on the near side of the wound and exits on the far side of the wound. The suture\u00a0is tied normally.<\/p>\n

<\/a>
Figure 2-12. The horizontal running suture.<\/figcaption><\/figure>\n

(1) Advantages. The horizontal mattress suture everts the skin edges\u00a0powerfully. A single horizontal mattress stitch can take the place of two simple ties,\u00a0thus saving time. This suture is less likely to rip through the skin.<\/p>\n

(2) Disadvantages. Puckering may occur if too much pressure is exerted.\u00a0There is less control than with other types of sutures.<\/p>\n

e. Subcuticular Suture<\/strong>. A subcuticular suture (figure 2-13) is essentially a\u00a0running horizontal mattress stitch. This suture is placed just below the dermalepidermae\u00a0junction. Enter the skin three to four millimeters from one end of the wound.\u00a0Burrow through the deep tissue to emerge in the subcuticular plane at the apex of the\u00a0wound. Then, pass the suture through the subcuticular tissue on alternate sides of the\u00a0wound. The point of entry should be directly across from the exit of the previous stitch.<\/p>\n

(1) Advantages. This type of stitch avoids suture marks and is best suited\u00a0for straight lacerations. Using absorbable suture material is excellent in cases where\u00a0the patient cannot be relied on to return for suture removal.<\/p>\n

(2) Disadvantages. Subcuticular suturing is more difficult to learn. Also,\u00a0this type of suturing takes time to perform.<\/p>\n

<\/a>
Figure 2-13. The subcuticular suture.<\/figcaption><\/figure>\n","protected":false},"excerpt":{"rendered":"

a. Running Suture. A running suture (figure 2-9) is similar to the simple suture\u00a0in technique. The difference is that the suturing material is not cut and tied with each\u00a0succeeding stitch. Multiple loops are made, starting at one end of the laceration and\u00a0working toward the other end of the laceration. For the final loop, enter the … Continue reading 2-7. ADVANCED SUTURING TECHNIQUES<\/span> →<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"parent":65,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-97","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/pages\/97","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=97"}],"version-history":[{"count":5,"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/pages\/97\/revisions"}],"predecessor-version":[{"id":354,"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/pages\/97\/revisions\/354"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/pages\/65"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=97"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}