Surgical suture patterns

Dr.Hiba.A.Shekho 4th Stage

Surgical suture patterns:-

These methods or techniques which are used for connecting ( sewing ) the
tissues together.

Classification of suture patterns:-

1-According to the number of passages through tissue on each side
of incision, suture techniques can be divided into the following:-

A- Simple:-
Directly apposes tissues by a single passage through the tissue on each side of
the incision & after that it is tied.

B- Mattress:-
Apposing tissues by double passages via the tissue on each side of the incision
after that it is tied.

C- Tension suture patterns:-

Are usually mattress suture techniques that are preplaced well back from the
skin edges so the tension is reduced on the outer primary sutured line.
Tension suture patterns usually have a value in suturing wound in aged or
debilitate patients when delayed healing is anticipated, also used for closing of
abdominal wounds or wounds over joints where movements can break the
suture line.

2-According to the position of wound edges following suture

placement:-

A- Apposing patterns:-
Bring the wound edges in direct apposition.
B- Everting patterns:-
Usually tend to turn the wound edges outward ( to outside).
C- Inverting patterns:-
Turn the tissue edges inward ( to inside).
D- Overlapping patterns:-
One edged of the wound will become over the other edge.
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3-According to the number of knots within the tissue or if each
suture bite is shortly & quickly severed & tied separately:-

A- Interrupted suture patterns:-

There are many knots within the tissue ( more than 2 knots ), that are shortly or
quickly severed & tied separately after one or two passages in the tissue.

B- Continuous suture patterns:-

There are only 2 knots within the tissue, they are not shortly or quickly cut, &
they run from point of origin to some relatively distant end point & then cut &
tied.

4-According to the kind of tissue to be sutured:-

A - External suture patterns:-

Include these techniques which are used for suturing of Skin, Subcutaneous
tissue, Fascia, Peritoneum & Muscles.

B - Internal suture patterns:-

Means these techniques which are used for suturing of internal hollow organs
which their walls consist of 4 layers ( mucosa , submucosa , muscularis , serosa
such as GIT , Urinary tract , Uterus …….etc).

C- Special suture patterns:-

Include these sutures that are used restrictedly for suturing of specific organs
such as Tendon which usually sutured by Bunnell suture technique.
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External suture patterns:-
Can be divided into:
A- Interrupted suture patterns:-
This pattern consist of
1-Simple interrupted suture technique:-
Each suture in this technique is individually tied & cut at a distance to the knot;
each suture is therefore a unit . Knot should be offset so that they don’t rest
upon the incision.

Advantages:-
1-It’s ability to maintain strength & tissue position if part of suture line fails.
2-Easy & rapid technique.
3-Decreased tissue edema following closing compared with continuous suture
patterns.
4-Produce tissue apposition.

Disadvantages:-
1-Greater amount of suture materials.
2-Time consuming.
3-Presence of additional suture materials within tissue in forms of knots.
4-Has minimum holding power against stress.
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2-Horizontal mattress:-
It’s a tension suture , useful in suturing the skin of large animals.

Advantages:-
1-Small amount of suture materials.
2-Rapidly applied.
3-Tension type of suture patterns.

Disadvantages:-
1-Causing excessive eversion of skin.
2-It’s tendency to decrease blood supply to skin edges.
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3-Vertical mattress:-
Also it’s a tension suture pattern; it’s stronger than horizontal technique . Vertical
mattress precise edge to edge apposition with slight eversion of edges when the
suture is tied.

Advantages:-
1-Tension type suture.
2-Provide tissue apposing.

Disadvantages:-
1-Time consuming technique.
2-Required increased amounts of suture materials.
3-Cause more inflammation owing to 4 penetrations by needle.
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4-Cross mattress suture or Cruciate mattress ( The X mattress):-
It’s modification of mattress suture; it’s resemble 2 simple interrupted sutures joint
together.

Advantages:-
1-Tension type suture patterns that provide strength.
2-Bringing tissue into apposition.

Disadvantages:-
1-Large amounts of suture materials.
2-Time consuming technique.
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B- Continuous suture patterns:-
This pattern consist of:-
1-Simple continuous suture pattern:-
Consist of series of simple interrupted sutures that are tied at the beginning & end
but are continuous between these 2 points.
Usually is used in tissue that required minimal holding with maximum tissue
apposition . Used for closure of subcutaneous tissue & fascia in non-tension areas
because it is undesirable for wound that are under tension & that are subjected to
increased mobility & distension pressure.

Advantages:-
1-Rapid & easy technique.
2-Minimal amounts of knots within tissue ( only 2 knots).
3-Minimal amounts of suture materials.
4-Easy to remove after wound healing.

Disadvantages:-
1-The success of the whole pattern is depending on each of its parts so knot slippage
or break is likely to cause failure of the entire suture line.
2-Increase wound edema.
3-Decrease blood supply to the wound edges.
4-Decrease tension strength.
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2-Lock-stitch or Ford interlocking suture or Reverdin’s suture pattern:-
It’s modified of simple continuous suture technique.

Advantages:-
1-Greater stability in the event of partial failure ( failure of knot is not necessarily
result in failure of the entire suture line).
2-Tension type suture techniques.

Disadvantages:-
1-Large amount of suture materials used & left in incision.
2-If it’s applied to skin suture is slightly difficult to remove.
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3-Subcuticular suture pattern :-
This technique is used to eliminate scars formation in tissue especially the skin so it
is usually used in cosmetic surgery, both absorbable & non-absorbable suture
materials can be used with this technique.

Advantages:-
1-Rapid technique.
2-Utilize very little suture materials.

Disadvantages:-
1-Does not have good strength.
2-Usually subjected to removed by biting, licking or scratching by domestic
animals.
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Internal suture patterns:-
Used for internal hollow organs; that having 4 layers in its wall
1-Lembert suture technique:-
It is an inverting continuous vertical mattress suture technique is applied from
out side of the lumen, with the needle passing through( the serosa, muscularis,
submucosa but not penetrate mucosa). This technique is perpendicular to the
incision.
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2-Connell suture technique:-
parallel to the wound & penetrates all layers of tissue (serosa, muscularis,
submucosa, mucosa).

3-Cushing suture technique:-

Parallel to the wound & penetrates only 3 layers of tissue ( serosa, muscularis,
submucosa).
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4-Schmieden’s suture technique:-
This technique penetrates all layers of wall from inside to outside ( mucosa,
submucosa, muscularis, serosa).
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Special tension suture patterns:-
1-Quilled & Stent suture technique:-
These techniques are designed for wounds that subjected to excessive pressure
& tension.

* Stent suture technique:-

This technique is made by incorporating sterile gauze sponge in a large simple
interrupted suture.

* Quilled suture technique:-

This technique is made by incorporating a rubber or plastic tube in the external
loop on each side of the incision that is sutured by either vertical or horizontal
mattress suture technique.

Quilled suture technique

Stent suture technique

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2-Far-Near, Near –Far & Far-Far, Near-Near suture technique:-
It’s a tension type of suture patterns that provide skin edges apposition.

Advantage:-
Apposes the skin edges & provides a degree of tension.

Disadvantage:-
Excessive amounts of suture material in the area, with double sutures in the
incision.

Far-Near, Near-Far

Far-Far,Near-Near
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4-Mayo mattress suture technique ( overlapping suture technique):-
It is useful for closure of midline abdominal incision of large animals & also for
repair of cleft palate; but the most important uses of mayo mattress is for
closing of Hernia ring.

5-Halsted Suture technique:-

When two vertical mattress sutures are placed in a parallel fashion before they
are tied. The pattern is known as a halsted suture. Some authors liked the
halsted suture by a Lembert suture with only two parallel but reversing passages
through the tissue. Used to suturing of parenchyma (spleen, liver, kidney).
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6-Donati`s suture technique:-
Modification of vertical mattress suture, have the same properties of vertical
mattress suture with minimum scar formation.

7-Parker-Kerr suture technique:-

A parker-kerr suture is modification of the Cushing & Lembert patterns that has
been advocated for closing the stump of hollow viscera. It is seldom used
because it also caused excessive tissue inversion. The parker-kerr suture
consists of a single layer of Cushing pattern covered by a layer of Lembert. This
double inversion is used for infected uterine stump & certain bowel closures.

Disadvantage:-
Is the presence of an outer layer that communicates between the serosa & the
lumen.
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8-Purse-string suture technique:-
Usually used for closing & inverting of the stump of a hollow organs.
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Types of surgical knots:-
There are many types of surgical knots . But all these knots must have the
following properties:-

1-Should be small in size to be more secure.

2-Ends of the thread should cut short to decrease foreign body reaction except
for catgut.

3-Excessive tension ( tying) must be avoided.

The most popular surgical knots are:-

1-Half-hitch knot.

2-Square knot.

3-Granny knot.

4-Surgeon knot.