Advanced Suturing Techniques

Bucky Boaz, ARNP-C

Subcutaneous Stitch

Deeper wounds or wounds under tension.

Inverted knot.

Begin at bottom of wound edge and come up.

Go straight across incision and down.

Running Stitch

Indicated for low risk repairs.

Tie knot at one end, do not cut until repair complete.

Faster technique.

Plastic surgery quality.

Running Locked Stitch

Modified running stitch.

Used to prevent slippage of loops as running stitch continues.

Allows for continuing stitch along irregular laceration.

Vertical Mattress Stitch

Promotes eversion of the skin.

Tension or very thick skin.

Enter wound on one side, pierce other side twice, and exit on side entered.

Horizontal Mattress Stitch

Needle is introduced in normal fashion.

Second bite is placed ½ cm adjacent to exit site.

Brought back next to original insertion.

Tie knot.

Intracuticular running sutureUsed to close linear wounds that are not under much tension.

Yields an excellent cosmetic result.

The ends of the suture do not need to be tied.

Taping under slight tension will preserve approximation.

Three-point or half-buried mattress suture

Closure of the acute corner of a laceration without impairing blood flow to the tip.

Three-point or half-buried mattress suture

Needle is inserted into nonflap portion of the wound at the mid-dermis level; and then at the same level, the suture is passed transversely through the tip and returned on the opposite side of the wound paralleling the point of entrance.

Three-point or half-buried mattress suture

The suture is tied, drawing the tip snugly into place in good opposition. This same approach can be utilized in closing a stellate 4- or 5-point laceration, drawing the tips together in a purse-string fashion.

Parallel Lacerations

The horizontal technique is used to cross all lacerations

Wound tapes can be used if low tension

If island in middle is wide enough, interrupted sutures can be used

Special Anatomic Sites

Extramarginal Lid Lacerations

Upper lid lacerations are usually closed with simple interrupted

Intramarginal lid lacerations are best left to plastics

Eyebrow lacerations

Most eyebrow lacerations can be closed without tissue debridement

If devitalized, excise tissue parallel to hair shaft

Ear72-hr window to drain perichondral hematomaSimple noncartilaginous lacerations are closed with interrupted or running suturesLacerations involving cartilage

Lip

Must approximate vermilion border

Through and through lacerations involve orbicularis oris muscle

Repair muscle first

Then, vermillion border

Then, rest

Questions?