Surgical Technology: Suture Technique

Technique

General Interrupted Techniques

  • Simple Interrupted (“Baseball Stitch”)
    • Most Fundamental Technique
    • Easy & Strong
  • Horizontal Mattress
    • Minimize Tension
    • Risk of Strangulation/Hypoxia at Edges
  • Vertical Mattress
    • Maximize Eversion
    • Minimize Tension
  • Deep Dermal
    • Buried Knot
    • Used to Reduce Tension Prior to Skin Approximation

A. Simple Interrupted, B. Horizontal Mattress, C. Vertical Mattress 1

General Running Techniques

  • Simple Running
    • Less Risk of Scarring
    • Faster for Long Repairs
  • Running Locked (Ford Interlocking)
    • Allows Each Throw More Independence
    • Good for Long Laceration with a Slight Curve
  • Running Horizontal Mattress
    • Better Cosmetically than Simple Running
  • Running Subcutaneous
    • Rapid
    • Through Deeper Subcutaneous Tissue
  • Running Subcuticular
    • Approximate Edges to Enhance Cosmetic Results
    • No Strength – Must Not Be Under Any Tension

A. Simple Running, B. Running Locked, C. Horizontal Mattress, D. Running Subcuticular 1

Edge-Inverting Techniques

  • Lembert
    • Inverts Edges to Close Hollow Organs
    • Does Not Involve Mucosa with Low Risk of Contamination
    • Can Produce Mild Stenosis of Bowel
  • Halsted (Interrupted Quilt)
    • Combination Lembert & Horizonal Mattress
  • Cushing
    • Bites Placed Parallel to Edge
    • Bites Do Not Penetrate the Lumen
  • Connell
    • Bites Placed Parallel to Edge
    • Bites Penetrate the Lumen

A. Lembert, B. Halsted, C. Cushing, D. Connell 1

Other Specialized Techniques

  • Brooke Suture
    • Used to Mature an Ostomy
    • Everts Mucosa Full-Thickness & Avoids Serosal Exposure to Stoma Output
    • Full-Thickness of Bowel to Proximal Seromuscular Layer & Then Dermis of Abdominal Wall
  • Purse String
    • To Close Hollow Organ or Round Defects
  • Figure-of-Eight
    • Adds Strength
    • Commonly Used for Bleeding Vessel Ligation

Brooke Suture

Purse String Suture

Figure-of-Eight Suture 2

Knots

Square Knot

  • Most Basic Knot
  • Two Throws in Opposite Directions

Surgeon’s Knot

  • Initial Throw is Pulled Through Twice
  • Second Throw in Opposite Direction
  • More Stable than Square Knot

Granny Knot

  • Two Throws in the Same Direction
  • Typically Referred to as Poor Technique
  • Not as Strong as Square Knot – Can Slip

Surgical Slip Knot

  • Keeping Tension on One End the Initial Knot is Thrown Twice in the Same Direction and then Pulled Tight
    • Purposeful Granny Knot
  • Following Throws in Opposite Directions to Lock
  • Allows Tightening of Knot to Ensure Strength

Aberdeen Knot

  • Throws – Suture End Partially Pulled Through Loop to Form a New Loop
  • Turns – The Number of Times the Final Suture End is Passed Through the Final Loop
  • “Ultimate” – 3 Throws & 2 Turns (Previously Recommended 6 Throws & 1 Turn)
  • Benefits: Stronger, More Secure & Uses Less Suture

Basic Suture Knots

Aberdeen Knot

Suture Removal Timing

Timing by Site

  • Face: 3-5 Days
  • Neck: 7 Days
  • Scalp: 7-10 Days
  • Trunk: 10-14 Days
  • Arms: 10-14 Days
  • Legs: 14-21 Days

References

  1. Madaktari Inc. Consultancy Medical Solutions Unit – MCMSU Dr. George Leo
  2. Rusnack F. emDocs (License: CC BY-4.0)