Week 3: Sutures Used for Each Layer of Incision

1. Running, or Continuous Stitch: The "Running" stitch is made with one continuous length of suture material. Used to close tissue layers which require close approximation, such as the peritoneum. May also be used in skin or blood vessels. The advantages of the running stitch are speed of execution, and accommodation of edema during the wound healing process. However, there is a greater potential for malapproximation of wound edges than with the interrupted stitch. 2. Interrupted Stitch: Each stitch is tied separately. May be used in skin or underlying tissue layers. More exact approximation of wound edges can be achieved with this technique than with the running stitch. 3. Mattress Suture: A double stitch that is made parallel (horizontal mattress) or perpendicular (vertical mattress) to the wound edge. Chief advantage of this technique is strength of closure; each stitch penetrates each side of the wound twice, and is inserted deep into the tissue. 4. Purse String: A continuous stitch paralleling the edges of a circular wound. The wound edges are inverted when tied. Commonly used to close circular wounds, such as a hernia or an appendiceal stump. 5. Smead-Jones/Far-and-Near: A double loop technique alternating near and far stitches. Commonly used for approximating fascial edges. 6. Continuous Locking, or Blanket Stitch: A self-locking running stitch used primarily for approximating
skin edges.

Absorbable sutures: Gut sutures: Used to close tissue that requires minimal support and heals rapidly, such as that of the oral cavity mucosal layer, or procedures of superficial blood vessels Vicryl sutures: Best for the lower layers of skin, and approximating muscle or fatty tissue Maxon and monocryl sutures: Used for sub-cuticular stitches and soft tissue approximation PDS: Used for stitches of muscle and fascia tissue

Non-absorbable sutures: Prolene sutures: Used in tissue of fascia, muscle or blood vessels Nylon sutures: Used for closure of skin, surgical incisions or drainage tubes Silk sutures: Typically used to tie off blood vessels or bowel segments