Suturing

   The goals of suturing are to minimize the chance of infection, control blood loss, approximate separated tissues avoiding dead space, and promote wound healing as aesthetically as possible.  These principles are true for trauma induced lacerations and surgical incisions alike.  The type and size of suture material and suturing technique(s) used should all be based on achieving these goals.

   

I am not going to delve into the type of material used any more than saying...

1. Use thicker suture for higher tension wounds

2. Use monofilament suture for wounds at higher risk of infection

3. Use absorbable suture to close dead space and for subcuticular techniques 

4. The thinner the material, the less scaring

   That being said, I am going present the suturing techniques that will be used for the vast majority of skin wounds that you will come across in an orthopaedic setting.  Including...

Simple Interrupted

Running

Horizontal Mattress

Vertical Mattress

Subcuticular Interrupted

Subcuticular Running

Tips to remember for all techniques...

1.  The needle should be held with the driver 2/3 distance of the needle away from the tip

2.  The needle should penetrate the skin at a 90° angle

3.  Advance the needle rotating the wrist, not "pushing" the needle

4.  The needle entry and exits should mirror each other in terms of distance from the wound edge and depth in the wound

5.  Passes should be evenly spaced 

6.  Do not tie too tight.  Doing so can overlap or invert skin edges and strangulate the tissue causing healing issues or worse scarring

7.  Visualize each step before you perform the task

8.  If you don't like it, cut it out and do it again