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FLORABELLE A.ANTONIO NOVEMBER 24, 2009NCM 102a 8-C

TYPES OF WOUND SUTURING

.Simple interrupted sutures

: most versatile suture technique and are goodforrealigning irregular wound edges and stellate lacerations with more meticulousapproximation of the wound edges. An advantage is that only the involvedsutures need to be removed in case of infection. Wound integrity is greater andthe risk of premature separation (dehiscence) is less because the wound is heldtogether with multiple individual suture loops.

2.Continuous running sutures:

quick, easy and may save time in the EDbecause only two knots are needed as each end of the laceration rather thanindividual knots for each interrupted suture loop. Continuous running sutures arebest when repairing linear wounds. A break in the a suture may ruin the wholerepair and cause permanent marks if placed too tightly. This type of suture isoften used where hemostasis is important such as vagina and scalp, wherelocking the running suture aids in hemostasis. Another advantage is that itaccommodates to the developing edema of the wound edge during healing.Two different patterns are used: Needle pathway is 90

to the wound edgeand results in a visible suture that crosses the wound edge at 45

angle. In theother pattern the needle pathway is 45

angle to the wound edges, so that thevisible suture is at a 90

angle to the wound edges. In either case the providerstart the continuous suture closure at the corner of the wound that is farthestaway and suturing progresses toward the provider, rather than away.

3.Dermal (subcuticular) sutures:

either continuous or interrupted may benecessary prior to skin closure to reduce tension and gaping.Interrupted dermalsutures are started by entering the skin near the base and exiting just beneaththe dermal epidermal junction. Continuous dermal sutures are useful in wounds subjected to strong skintensions, patients prone to keloid formation, children frightened by sutureremoval and those individuals unable to contact health professional for sutureremoval. Absorbable synthetic braided or monofilament sutures are ideally suitedbecause they do not have to be removed. Continuous dermal sutures can be usedby themselves when percutaneous sutures might cause cosmetic problems. Theyare ideal for linear facial lacerations, where sutures placed below the surfaceminimize scaring.

4.Vertical mattress suture:

allow for precise edge to edge alignment and areespecially good to match thick to thin skin. This suture enhances skin edgeeversion and avoids the tendency for inversion common with deep nonlinearlacerations.

5.Horizontal mattress suture:

faster and better at eversion than verticalmattress. The repair may look poor early on, but with good eversion, the scar willhave a better cosmetic effect in 2-3 months. This suturing technique may be

faster because it covers more linear distance. It is especially useful in areas of increased tension such as fascia, joints, and callused skin.

6.Horizontal have buried sutures:

good for repairing flaps and triangularwounds. It minimizes tissue tension so it doesn’t strangulate the interposedtissue. Similar to vertical mattress sutures, horizontal half buried sutures are alsouseful to approximate thick to thin edges.

7.Purse string suture:

useful at re-approximating multiple flap tips and cornerwounds back together. This technique is used in these areas in order to preservethe blood supply and minimize tissue destruction at the tips of skin edges.

8.Dog ear maneuver:

technique used to handle excess tissue at one end of thewound. Basically the wound is extended from the apex toward the long side inthe form of a hockey stick. Then the triangular piece of excess skin is removedand the skin edges are sewn together. TYPES OF WOUND SUTURE1.

Absorbable suture

is used in mucosal areas such as the oral cavity andtongue and disintegrates by one of two methods: enzymatic breakdown of organicmaterial (e.g., surgical gut- plain or chromic) or by hydrolysis of synthetic material(e.g., polyglactin 910 Vicryl).

2.Non-absorbable suture

is made of silk, stainless, nylon, polypropylene, orpolyester fiber. They can be further broken down into monofilament or multifilament. Monofilament passes through tissue more easily than braided suture,though it has less tensile strength. A multifilament suture has better flexibility, yetit may harbor organisms more easily within the braid.

Removing Stitches Introduction

Among the many methods for closing wounds of the skin, stitching, or suturing, isthe most common form of repairing a wound. Other methods include surgical staples,skin closure tapes, and adhesives.

Stitches

(also called sutures) are used to closecutsand wounds in skin. They canbe used in nearly every part of the body, internally and externally. Doctors literally"sew" the skin together with individual sutures and tie a secure knot. Stitches then allowthe skin to heal naturally when it otherwise may not come together.If you've received stitches, you will be given instructions for taking care of your stitchesand wound.1.Keep wound clean and dry for the first 24 hours.2.Bathing is allowed after 48 hours.3.Bandages can safely be removed from the wound after 48 hours, unless the woundcontinues to bleed or has adischarge. If bandages are kept in place and get wet, thewet bandage should be replaced with a clean dry bandage.

4.Anantibiotic ointment(brand names are Polysporin or Neosporin, for example) should be used after the wound is cleaned.5.Notify your doctor if a suture becomes loosened or breaks.6.Return when scheduled to have your stitches removed.*Different parts of the body require suture removal at varying times. Common periodsof time for removal are these:

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Face - 3-5 days

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Scalp - 7-10 days

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Trunk - 7-10 days

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Armsand legs - 10-14 days

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Joints - 14 daysSutures may be taken out all at one visit, or sometimes, they may be taken out over aperiod of days if the wound requires it.

STEPS IN REMOVAL OF WOUND SUTURE

Removing stitches (sutures)1.The wound is cleaned with an antiseptic to remove encrusted blood and loosened scartissue.2.Sterileforceps(tongs or pincers) are used to pick up the knot of each suture, and thenthe surgical scissors or a small knife blade is used to cut the suture. Forceps are usedagain to remove the loosened suture and pull the thread from the skin.3.These relatively painless steps are continued until the sutures have all been removed. You may feel a tug or slight pull as a stitch is removed.4.The wound is cleansed again.5.Adhesive strips are often placed over the wound to allow the wound to continuestrengthening.

After the Procedure

1.Wound careafter suture removal is just as important as it was prior to removal of thestitches. Take good care of your wound so it will heal and not scar.2.Keep adhesive strips on the wound for about 5 days. Then soak them for removal. Donot peel them off.3.Continue to keep the wound clean and dry.4.Skin regains tensile strength slowly. At the time of suture removal, the wound has onlyregained about 5-10% of its strength. Therefore, protect the wound frominjuryduringthe next month.5.Injured tissue also requires additional protection from sun's damaging ultraviolet raysfor the next several months. The use of sunscreenduring this period of healing is welladvised for those areas that are exposed.6.The use of vitamin Etopically has also been suggested to be helpful in the healingprocess of the damaged skin. This should only be considered once the skin edges arehealed and are closed together.