Applying sutures involves a series of precise steps to close wounds effectively. The general technique involves passing a needle with attached suture material through tissue to bring wound edges together. The video reference highlights one approach: achieving dermal closure without "button holing" the skin. Here's a breakdown of a common suturing technique:
Basic Suture Technique
This outlines one example - a simple interrupted suture.
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Preparation:
- Gather necessary materials: suture material, needle holder, tissue forceps, scissors, antiseptic solution, sterile gloves.
- Clean and anesthetize the wound area.
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Needle Handling:
- Load the needle into the needle holder. Grasp the needle body approximately one-half to two-thirds of the distance from the swaged end (where the suture is attached).
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First Pass:
- Grasp one edge of the wound with tissue forceps.
- Insert the needle into the skin at a 90-degree angle, a short distance (e.g., 0.5-1 cm) from the wound edge.
- Advance the needle through the tissue. The video excerpt describes going "superficial and end[ing] up in the dermis." Aim for consistent depth.
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Second Pass:
- Release the tissue forceps on the first side.
- Grasp the opposite wound edge with tissue forceps.
- With a continuous motion, bring the needle across the wound and insert it into the second side at a similar distance from the wound edge as the first pass. The video highlights going "superficial" then "deep" on this side, aiming to mirror the first pass and achieve symmetrical closure.
- Follow the curvature of the needle as you pass it through the tissue.
- Ensure the needle exits the skin at a similar depth and distance from the wound edge as the entry point on the first side.
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Knot Tying:
- Grasp the needle holder and wrap the suture tail around the jaws of the needle holder twice.
- Grasp the free end of the suture with the needle holder.
- Pull the suture through to create the first throw of the knot. This should create a square knot.
- Repeat the knot-tying process, but wrap the suture tail around the needle holder only once for subsequent throws. Typically, 3-4 throws are needed for a secure knot.
- Ensure each throw is laid down flat and square to prevent slippage.
- Be careful not to tie the knot too tightly, which can strangulate the tissue.
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Cutting the Suture:
- Cut the suture ends, leaving approximately 0.5-1 cm tails.
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Repeat:
- Place additional sutures along the wound at appropriate intervals (e.g., 0.5-1 cm apart) to close the wound completely.
Considerations
- Suture Material: Choose the appropriate suture material based on the tissue type, location of the wound, and desired tensile strength. Common suture materials include nylon, polypropylene, silk, and absorbable sutures like vicryl.
- Needle Size and Type: Select the appropriate needle size and type (e.g., cutting, tapered) based on the tissue being sutured.
- Wound Tension: Avoid placing excessive tension on the sutures. Undermining the skin or using deeper sutures may be necessary to relieve tension.
- Aseptic Technique: Maintain strict aseptic technique throughout the suturing process to prevent infection.
- Proper Training: Suturing requires proper training and practice. It is essential to learn from experienced clinicians.
- Avoiding Button Holing: The reference video emphasizes avoiding "button holing," which refers to creating small holes or tears in the skin when placing sutures. This occurs when the needle exits the skin at an incorrect angle or when excessive tension is applied.
- Depth and Symmetry: Achieving proper depth and symmetry is crucial for optimal wound healing and minimizing scarring.
