Treatments for an open wound injury or a surgical procedure often require the use of stitches, or sutures. Two primary types of suture techniques exist: the continuous suture and the interrupted suture. The former uses one piece of thread and knot, while the latter makes use of several threads and knots. A continuous suture may be further classified into subtypes like the purse string suture and the blanket suture. Other suture techniques include the Smead-Jones suture and the mattress suture.
Sutures are often vital components in recovering from an injury. Regardless of specific suture techniques, suturing closes an open wound sustained via trauma or surgical incisions. As such, stitches help facilitate healing by keeping out dangerous infectious agents and by encouraging new skin growth. Improper suture techniques can therefore hinder recovery and perhaps even worsen a condition. Some sutures are designed to be permanent, others are removed after a period of time, while some are made from materials that eventually dissolve without the need for manual removal.
Several factors influence the selection of suture techniques. The nature of the wound may impact which suture a physician ultimately chooses. In addition, the wound’s location and the thickness and elasticity of the skin surrounding the wound will also play a role in decision-making. Most techniques will, however, make use of the same basic equipment: needles, a needle holder, forceps, and the suture thread.
If one long piece of suturing thread is used, the physician is likely performing a continuous or running suture. A typical suturing technique like this will include placing the needle in the needle holder and then pushing the needle through the skin a few millimeters from the wound at about a 90 degree angle. Forceps help keep the skin stable and also anchor the needle as it leaves the skin. In continuous sutures, the thread is continually looped over and under the wound with the needle. Tied knots are used to secures sutures at both ends.
This technique is generally used for wounds that must be secured tightly and that are on upper layers of the skin. If the needle is consistently passed through already-created loops, the suture is further classified as a locking suture, or a blanket suture. The purse string is a variation of the continuous stitch used primarily for circular injuries. While these techniques are quicker, they are also more prone to error.
An interrupted suture, on the other hand, necessitates that different threads be placed across the wound with the needle. Each thread is then tied with individual knots. While the process is slower, accuracy may be better achieved and the removal process may be less painful.
Some sutures are secured twice on each side, and the suture is planted deeper into body tissues. For example, in a Smead-Jones suture, the sutures are looped twice. Perhaps the strongest suture type, the mattress suture works well with fragile skin areas. It is an interrupted stitch in which the thread is taken under the wound, reversed, and then taken underneath the wound again in the opposite direction before being tied into a knot. This technique is often used for deeper lesions like those obtained in abdominal surgery.