Sutures

Sutures, also known as stitches, are sterile surgical threads used to repair
cuts. They are also commonly used to close incisions from surgery. Some
wounds may require an alternative method like metal staples instead of
sutures. It all depends on the wound
Sutures are used to close deep wounds or cuts. When a deep wound is
present, a doctor may need to sew the two edges of the wound together
layer by layer. When this happens, sutures are left under the surface of
the skin and ultimately close the wound.
There are two varieties of sutures: absorbable and non-absorbable.
Absorbable sutures do not require your doctor to remove them. The
enzymes found in the tissues of your body will naturally digest
them.
Nonabsorbable sutures will need to be removed by your doctor in the
days or weeks following your procedure, or may be left in permanently.
Sutures are typically made from a variety of materials that are natural or
synthetic.
-Nylon: Nylon creates a type of natural monofilament suture
-Polypropylene (Prolene): This material creates a monofilament suture.
-Silk: Silk sutures are typically braided and made naturally
-Polyester: This form is synthetic and braided
Types of sutures:
Gut suture: This form is a natural monofilament suture used to repair
internal soft tissue wounds and is most common in gynecological
surgeries.
Polydioxanone (PDS): This synthetic monofilament suture can be used
for soft tissue repairs like abdominal closures.
Poliglecaprone: This synthetic monofilament suture is used for general
use in any soft tissue repair. However, this material should be avoided in
cardiovascular procedures. It’s most commonly used to close skin in an
almost invisible-like manner.
Polyglactin: This synthetic braided suture is good for repairing hand or
facial lacerations.
How to care: It’s important to keep sutures clean and dry. You should
only use creams and lotions if recommended by your doctor. You’ll need
to keep them dry, too; if they get wet, change them.
You should avoid physical activities, After 24 hours, you can wash the
sutured area gently and quickly, either in a sink or in the shower.
Carefully pat the stitches dry.
It’s best not to soak the wound in a bath or go swimming until it has
healed and the stitches have been taken out or have dissolved.
Pain from the wound and sutures can usually be managed with simple
pain relief medicine such as paracetamol. As the wound heals, don’t pick
at the stitches or scab. Picking at it might increase scarring.
Long-term care: At first, the scar will be red and raised, but over time it
will become paler and more flexible
For the first year, protect the scar from sun damage which can make it
darker.
How long do sutures take to heal?
Stitches are often removed after 5 to 10 days, but this depends on where
they are. Check with the doctor or nurse to find out.
Dissolvable sutures may disappear in a week or 2, but some take several
months.
The Role of Sutures in Wound Healing
1. To understand the impact of medical errors on patient safety.
2. To understand the Joint Commission's new patient safety standards.
3. To understand the integration process and how it affects infection
control and patient safety
The healing go into three stages
swelling stage:- Blood vessels in the area of the cut begin to form -1
clots that keep you from losing too much blood. White blood cells move
into the wound to fight bacteria. Takes 6 days after your surgery, it's
normal to see some redness, swelling, and it may hurt around the site.
Signs of infection in this stage are oozing pus that smells bad and the
pain, redness, and swelling don't go away or are getting worse.
Stage 2: Rebuilding. This part of your healing lasts from about 4 days to
a month after surgery. The edges will pull together, and might see some
thickening there. It's also normal to spot some new red bumps inside the
shrinking wound. feel sharp, shooting pains in wound area might happen.
This may be a sign that getting sensations back in the nerves. The feeling
should become less intense and happen less often over time.
Stage 3: Remodeling. The wound has filled in and a new surface has
formed. This stage lasts from 6 months to 2 years. some changes occur in
the scar. It will go from looking thick, red, and raised to thinner, flatter,
and more like the usual skin color.
the first month postoperative the wound could be infected if you have:
Fever
Delay in your healing
Pus, redness, and pain getting worse
Tenderness, warmth, and swelling near your wound
Most of the time, infections in the area of your wound can be treated with
antibiotics.
Patient Factors Affecting Wound Healing
The choice of suture material by the surgeon depends greatly on the
overall condition of the patient. Elderly patients' skin and muscle tissue
lose tone and elasticity and their circulation may be impaired, which also
lengthens healing time. Obese patients are at risk for post-operative
wound infections because excess adipose tissue at the wound site may
prevent good approximation of tissues. Adipose tissue does not have a
good blood supply, therefore making it vulnerable to trauma or infection.
The nutritional status of the patient can effect wound healing. A lack of
carbohydrates, proteins, zinc, and vitamins can cause a delay in healing.
Without adequate nutrition, collagen synthesis-which is the basis for
wound healing-- cannot properly occur.
Dehydration, causing electrolyte imbalance, not only can affect cardiac,
kidney, and hormonal function, it also can decrease oxygenation to the
tissues, thereby affecting wound healing. Lack of blood supply at the
wound site can also slow healing.
There are many suturing techniques that can be used in different
Situations
*Here are the most common techniques
Simple interrupted suture: its the most common and simplest
technique. Aneedle is put into the wound from one side and emerges from
the wound itself. Suture should extend through the full depth of the
dermis. The needle is reinserted into the wound on the opposite side at the
same level and emerges from the skin at the same distance from the edge
of the wound as the initial insertion. Sutures need to be put roughly 2 to 5
mm from the edge of the wound and spaced 5 mm apart (may vary
depending on the location and size of the suture). To evert the edges of
the wound, the forceps or a finger could be used.
its better to suture from the more mobile to the more fixed edge. Knots
can be used to gently modify the edges to lie together by being placed on
either side of the wound's edge.
Vertical mattress suture:
Promotes eversion of the wound edges. better used with poorly supported
or mobile skin. Needle insertion is same as the simple interrupted suture
almost 5mm from the wound edge and brought out the opposite side in
the same way.
Needle is then reinserted closer to the wound edge on the emergent side
(approximately 1-3mm) and a shallow bite is taken back across the
wound from the emergent side to the original side, coming out of the skin
closer to the wound edge than the original insertion point (‘Far Far Near
Near’) The knot is then tied on the original insertion side.
Horizontal Mattress Suture:
it is more useful in the palm and other glabrous areas as well as wounds
under tension. Distributes tension across a wound more than the simple
interrupted suture
there is Increased risk of tissue hypoxia compared to other techniques.
Needle is inserted same way as the simple interrupted suture and brought
out the opposite side in the same way. Needle is then re-inserted adjacent
to the emergence point on the far side of the wound and brought out on
the near side (i.e. like 2 simple interrupted sutures placed next to each
other but traversing the wound in opposite directions; the path of the
thread forms a rectangle. the knot is tied on the original.
Subcutuicular suture:
it is a continuous suture which spreads wound tension. it leaves no marks
on skin as the suture is placed within the superficial dermis
Requires little wound tension so deep dermal sutures are mandatory
Knots can be tied at the start and the end of the suture or can be left
without knots- the purpose of this suture is to oppose the wound edges,
not to provide support as these wounds should be under minimal tension
Needle is inserted approximately 1cm from one end of the wound and the
needle brought out within the superficial dermis at the apex of the wound
A knot can be tied at this point within the wound/outside the wound, or
the suture can be continued as below and any knots placed at the end
Needle is then inserted into the dermis on one side of the wound at the
same level and brought out at the same level further along the wound
Needle is then inserted into the superficial dermis at the same level on the
opposite side at the same point in the wound as the emergence point from
the previous bite and brought out at the same level. This should be
repeated the full length of the wound, taking even horizontal bites. At the
end of the wound the needle should be inserted into the superficial dermis
at the apex and brought out approximately 1cm from the wound edge
The suture will look like a ladder across the wound with no emergence
through the skin except at the start and end. Knots can be tied at each end
or the ends left exposed and secured with steri-strips which can be used
on the top of the wound for further wound protection.
Deep dermal suture:
Used to provide support to wounds and eliminate dead space in the
wound. Needle is inserted into the wound beneath the dermis and brought
out in the dermis, again into the wound. Needle is then inserted into the
dermis on the opposite side and brought out into the wound at the same
level as the original insertion. Knot is then tied within the wound and
buried beneath the skin.
The suture should be cut flush to the knot to ensure the ends do not
protrude up out of the wound.