Sutures are placed by mounting a needle with attached suture into a needle holder. The needle point is pressed into the flesh, advanced along the trajectory of the needle’s curve until it emerges, and pulled through. The trailing thread is then tied into a knot, usually a square knot or surgeon’s knot. Sutures should bring together the wound edges, but should not cause indenting or blanching of the skin,since the blood supply may be impeded and thus increase infection and scarring.Sutured skin should roll slightly outward from the wound (eversion), and the depth and width of the sutured flesh should be roughly equal.Placement varies based on the location, but the distance between each suture generally should be equal to the distance from the suture to the wound edge, in accordance with Jenkin’s Rule. Many different techniques exist.
The most common is the simple interrupted stitch; it is indeed the simplest to perform and is called “interrupted” because the suture thread is cut between each individual stitch. The vertical and horizontal mattress stitch are also interrupted but are more complex and specialized for everting the skin and distributing tension. The running or continuous stitch is quicker but risks failing if the suture is cut in just one place; the continuous locking stitch is in some ways a more secure version. The chest drain stitch and corner stitch are variations of the horizontal mattress. Other stitches or suturing techniques include: Purse-ring suture, a continuous, circular inverting suture which is made to secure apposition of the edges of a surgical or traumatic wound Figure 8 stitch Subcuticular stitch.
In contrast to single layer suturing, two layer suturing generally involves suturing at a deeper level of a tissue followed by another layer of suturing at a more superficial level. For example, Cesarean section can be performed with single or double layer suturing of the uterine incision.
While some sutures are intended to be permanent, and others in specialized cases may be kept in place for an extended period of many weeks, as a rule sutures are a short term device to allow healing of a trauma or wound. “Different parts of the body heal at different speed. Common time to remove stitches will vary: facial wounds 3”“5 days; scalp wound 7”“10 days; limbs 10”“14 days; joints 14 days; trunk of the body 7”“10 days. “Not all stitches must be removed. If a small area remains unhealed, notify the health care practitioner. Then if ordered, remove sutures from the healed area only.”
A pledgeted suture is one that is supported by a pledget, that is, a small flat absorbent pad or piece of cloth, in order to protect a wound.