Subtleties of Suture Techniques
Suture techniques are used for minimal traumas. Tissues should not be traumatized while using sewing instruments. Suture techniques should be followed with skin lines and contours. The suture starts from the subcutaneous tissue at the base of the wound, symmetrically entered from the opposite side, exited from below and knotted. Suture material is cut at a distance of 5 mm from the knot. Sutures should be placed in mirror image and the knot of the suture should be placed on one side of the wound.
If the edges of the wound are folded or one edge is below the other, it is poorly formed and a pronounced scar tissue is formed. To achieve an optimal result, the epidermis should be gently inverted without excessive suture tension. Dead space should not be left.
Sutures do an excellent job of preventing infection. It provides advantages such as regaining the functions of the injured areas and restoring the physical appearance.
Choosing the Right Suture
Choosing the correct suture depends on the biological structure and anatomical location of the wound. Suturing is a surgical procedure that has been performed by humans for 4000 years. South American Indians sewed the heads of war ants as pliers. The ancient Greeks made use of horsetail hair attached to sharpened bones. This surgical material, which has been used for 4000 years from past to present, is still an indispensable element of medical surgical interventions. Nowadays, with the increase of technological possibilities, seams have gained a much more ergonomic structure. Surgical incisions are the best and easiest to close with stitches. The materials required for sewing are simply needles, threads, and surgical instruments. Support, scissors and forceps are sufficient tools for suture use.
The key to success in dermatological surgery is the selection of appropriate suture materials. The type and localization of the procedure to be performed and the experience of the dermatology surgeon are important factors in this selection. Thanks to the technology developed in recent years, the thread is combined with the needle. This prevents the thread from doubling on the back of the needle, forming lumps and causing further tissue damage.
Suturing and Procedures
It can be extended for 3-7 days in the facial area, 7-10 days in the scalp area, 10 days in the trunk, 10-14 days in the arms and hand, and 10-14 days in the lower extremities. There are factors that disrupt wound healing. The first 6-8 hours after the injury is an important process for the healing of the wounds and the settling of the stitches. Some wounds can be closed for up to 8-12 hours without risky additions. Facial wounds can be closed 12-24 hours after injury with low risk.
Which Suture, Where Is It Preferred?
Mattress suture is preferred for incisions with excessive wound tension. Vertical mattress is the most preferred method. However, it may cause more ischemia and necrosis than simple or continuous suture. Starting from one end of the wound, the continuous suture is sewn continuously without knotting. Fast, additional resistance is advantageous, less knotted and more effective in hemostasis. It is not used to cover wounds in the joints. It can be opened completely when it is opened from somewhere, if infection develops, it cannot be opened with a single point incision. Continuous subcuticular suture is ideal for children or non-cooperative patients as this technique does not need to be removed when applied with absorbable material. Usually used for cosmetic closure.
What is a stapler?
Stapler made of high quality stainless steel. Its primary use is to close wounds on the body, extremities and scalp with high tension. It is also useful in protecting split thickness skin grafts. However, it is not applied to sensitive structures, bone protruding areas and highly mobile areas.
What is a strip?
The most important indication is to close superficial lacerations under little tension. If necessary, the tension can be reduced with deep closing stitches. The anterior part of the neck, chin, rib cage and extra-articular areas of the extremities are suitable for tape attachment.