Suturing Principles

Suturing principles have been used for centuries as a method of wound closure. Although techniques have changed and the variety of available suture materials has increased, the guidelines have remained the same.

Benefits of Suturing

With suturing, the tissues are supported until the healing process regains its tensile strength. Thanks to suturing, it is possible to minimize the risk of bleeding and infection. Thanks to suturing, it is brought closer to the wound edges and the dead space is closed and a functional and aesthetically pleasing result is obtained.

By suturing, most small wounds are applied for primary closure by stitching or other techniques such as applying adhesive skin closure strips or using tissue adhesive. Suturing principles include such processes. It is important to thoroughly evaluate the wound to establish the most appropriate method for any traumatic wound. The suturing process starts after this point.

The initial appearance of a small traumatic wound at the suture site can be deceiving. The visual aspect of torn and damaged skin, the amount of bleeding, and an obviously suffering patient who often appears ‘shocked’ may cause the nurse to assume that the injury is worse than it actually is. Conversely, at the point of suturing, tendon and nerve damage and more serious injuries are often overlooked because the patient does not complain of pain so quickly. Bleeding in a wound affects every stage of treatment and should be controlled by making an accurate assessment of the injury. After the bleeding is controlled, the wound may be evaluated. The suturing process starts after this point.

Suturing Method

The choice of Suturing Method will depend on the information obtained from the wound evaluation. For example, it would not be appropriate to use adhesive skin closure strips to cover a wound on a joint as the necessary tension cannot be achieved. However, the strips are ideal for use in pretibial lacerations where the skin is often too thin to sew up effectively.

Stitch and Needle Selection

Suturing a wound is the traditional method of primary closure. The wide range of sewing materials available makes it extremely versatile. The choice of suture and needle will be determined by the location of the wound, the thickness of the surrounding skin and the amount of tension that is likely to be applied on it. Suture materials are classified as natural or synthetic and can be absorbable or non-absorbable. Absorbable sutures break down rapidly and are used mainly in the deep tissue layers of a wound to minimize the risk of hematoma formation or infection occurring in the dead space. They are also used to cover wounds on the lips, tongue or mouth. Non-absorbable sutures are used to cover the wound edges in other areas.

It is usual to choose a reverse cutting needle for sewing, designed for use on hard tissues such as leather. Needles have three sections: the tip, the stem or mid-section, and the mold to which the suture material is attached. In reverse incisor needles, the cutting edge is placed in the outer fold of the body and directed away from the wound edges, preventing further trauma and the risk of pulling the suture from the edge of the wound.

Removal of Sutures

It indicates the recommended time for removal of commonly used sutures. This depends on where the wound is located. For example, facial scar stitches can be removed after three days and replaced with adhesive skin closure strips. The seam should be carefully and precisely cut out with sharp scissors or stitch cutter as close to the tissue as possible so that a minimum of material is pulled. Areas where healing is delayed can be supported by using adhesive skin closure strips.

Suture Complications

Complications from suturing can occur, especially if solid asepsis is not maintained throughout the procedure. The suture line provides an entryway to bacteria and must be kept clean and dry until initial healing to prevent infection. Care should also be taken in wound edge alignment to ensure a good cosmetic surface. Sutures should not be too tight as this may cause devitalization of the tissue at the edge of the wound. They should also not be too loose, as this may lead to inadequate adhesion of the wound edges, resulting in delayed healing and a poor cosmetic result.