Suture

Suture
Estefanía Rivas-García
Introduction
The skin is the body's largest and primary
protective organ, covering its entire external
surface and serving as a first-order physical barrier
against the environment. Its functions include
temperature regulation and protection against
trauma, pathogens, and toxins. The skin also plays
a role in immunologic surveillance, sensory
perception, control of insensible fluid loss, and
homeostasis.
9/3/20XX Presentation Title 2

Skin
anatomy
The skin is made up of 3 layers:
• Epidermis
• Dermis
• Subcutaneous fat layer
(hypodermis)

Epidermis
Thin outer layer of the skin. It consists of 3
types of cells:
•Squamous cells. The outermost layer is
continuously shed is called the stratum
corneum.
•Basal cells. Basal cells are found just under the
squamous cells, at the base of the epidermis.
•Melanocytes. Melanocytes are also found at
the base of the epidermis and make melanin.
This gives the skin its color.

Dermis
Middle layer of the skin. The dermis contains the following:
•Blood vessels
•Lymph vessels
•Hair follicles
•Sweat glands
•Collagen bundles
•Fibroblasts
•Nerves
•Sebaceous glands
Is held together by a protein called collagen. This layer gives
skin flexibility and strength. The dermis also contains pain and
touch receptors.
Hypodermis
Deepest layer of skin. It consists of a network of collagen and fat cells.
Helps conserve the body's heat and protects the body from injury by acting
as a shock absorber.

1. Protection: It provides a barrier against
aqueous, chemical or mechanical injury,
viral or bacterial invasion and
environmental irradiation.
Skin 2. Thermoregulation: It does this by utilizing
the circulatory system and by
physiology 3. Sensation: It contains nerve receptors
which are sensitive to the stimuli of pain,
temperature, pressure and touch.
4. Metabolization: The biosynthesis of
Vitamin D takes place in the skin and this
is important for bone structure and
formation.

Types of wounds
a) Abrasions:
• Commonly referred to as “brush burn” and
caused by skin rubbing on hard surfaces,
the friction removes epithelial cells and
possibly dermal. Healing is by secondary
intention.

Types of wounds
b) Abscess:
• A cavity containing pus and surrounded by
inflamed tissue formed as result of
suppuration in a localized infection.
Healing usually occurs when abscess is
drained or excised.

Types of wounds
c) Avulsion:
• This type of wound produces full thickness
skin loss. Healing is by secondary
intention.

Types of wounds
d) Contusion:
• Collection of blood under the tissues
without breaking the skin's integrity.

Types of wounds
e) Laceration:
• Two types of laceration
- Superficial (involves dermis/epidermis)
- Deep (extends through tissues) repair is by
primary intention

Types of wounds
f) Puncture or Incision:
• Penetration of the tissues by a sharp object.
Healing is by primary intention.

Healing Process
1 2 3 4
Inflammatory Stage: Destructive Stage: Proliferative Stage: Maturation Stage:
Few minutes of wounding, lasts 2 to 5 days, breakdown of 3 to 24 days, Strands of 24 days to 1 year, progressive
approximately 3 days, Redness, unwanted fibrin and dead cells, collagen are produced decrease in the vascularity of the
swelling and local heat, osmolarity to the areas is (granulation) . scar, skin tissue change.
Coagulation factors, growth increased.
factors, histamine.

Sutures
Material
Absorbable Non-absorbable
• Enzymes found in the tissues of your • Removed by your doctor
body will naturally digest them.
Type Absorbable Non-absorbable Monofilament Multifilament
Nylon X X
Vicryl X X
Chromic gut X X
Polyester X X
Suture Size
The diameter of the suture will affect its handling properties and tensile strength. The
larger the size the smaller the diameter.
USP SIZE SUGGESTED INDICATION
11-0 & 10-0 Ophthalmology, microsurgical repair
9-0 & 8-0 Ophthalmology, microsurgical repair
7-0 & 6-0 Small vessel repair/grafting, fine suturing on the hand/nailbed
& face
5-0 & 4-0
Larger vessel repair, skin closure (hands/limbs, face) tendon
repair
3-0 & 2-0 Closure of thick skin, fascia, muscle, tendon repair
0&1 Closure of fascia, drain stitches

2 and above Large tendon repairs, thick fascial closures, drain sutures
(usually orthopedic surgery)

Stitches
• Simple
• Simple continuous
• Continuous subcutaneous
• Continuous locked
• Horizontal mattress
• Vertical mattress
• Angle

Simple

Simple continuous

Continuous intradermal

Continuous locked

Horizontal mattress

Vertical mattress

Angle

Common mistakes

Wound Cleansing
Most important aspect of wound management.
- Irrigate, clean or even scrub the wound should be considered. Wounds that are obviously contaminated
should be thoroughly irrigated, then cleaned with a broad-spectrum antiseptic solution.

Basic Steps
1. Gently lift the skin with forceps and pierce the skin surface with the needle at a 90-degree angle to the
skin, approximately 4mm from the wound edge.
2. Bend your wrist backward so the needle passes through the dermis and rises out of the middle of the
wound.
3. Use your forceps to hold the needle while you release the needle holder.
4. Re-grasp the needle in the same place with the needle holder.
5. Lift the opposing skin edge gently with your forceps.
6. Now the needle needs to travel perpendicularly through the dermis from the inside to the outside. Use the
curve of the needle and your wrist to move the needle through the skin. The distance should be the same
as on the entry side.
7. Use the forceps to grasp the needle and pull it through the skin. This will follow the needle’s curvature as
it travels through the skin. To tie the knot, put down the forceps and pull the suture so there is
approximately 3cm of length on the opposing side.
8. Hold the suture in your non-dominant hand and the needle holder in your dominant hand.

1. Loop the suture away from you around the needle holder twice, then grasp the suture end with the
needle holder. Next, pull the needle holder towards you and push your non-dominant hand away
to lay the first knot.
2. Let go of the suture with your needle holder but keep holding it with your non-dominant hand.
3. Loop the suture back towards you around the needle holder once and grasp the suture end with
the needle holder. Then, push the needle holder away and bring your non-dominant hand towards
you to lay the second knot.
4. Loop the suture away from you around the needle holder once, then grasp the suture end with
your needle holder. Pull the needle holder towards you and push your non-dominant hand away to
lay the final knot.
5. Once the knot is tied, use the needle holder to pull the knot to one side so it is not overlaying the
wound.
6. Cut the suture between 5-6mm in length.

Thank you

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Type Absorbable Non-absorbable Monofilament Multifilament

0&1 Closure of fascia, drain stitches

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