√ Surgery: Suturing Techniques

Different types of suture with videos. To learn the basics of suturing prior to trying these out click below.

Most simple suture to use and suitable for almost all situations

Needle is inserted in one side of the wound and out through the wound itself

Suture should extend through the full depth of the dermis

Needle re-inserted at the same level in the opposite side of the wound and emerges out of the skin the same distance from the wound edge as the insertion

Sutures should be placed approximately 2-5 mm from the wound edge and 5mm apart (this may vary depending on the size of the wound and location)

Use the forceps or a finger to evert the wound edges

Try to suture from the more mobile edge to the more fixed edge

Knots should be placed on either side of the wound edge and can be used to subtly adjust the edges to lie together

Promotes eversion of the wound edges

Useful for poorly supported or mobile skin

Needle is inserted as per the simple interrupted suture approximately 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

Distributes tension across a wound more than the simple interrupted suture

Useful suture in the palm and other glabrous areas as well as wounds under tension

Increased risk of tissue hypoxia compared to other suture types

Needle is inserted as per 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 side of the wound

Continuous suture which spreads wound tension

No marks on skin surface as suture is placed within the superficial dermis

Requires little wound tension therefore deep dermal sutures are essential

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 i.e. a horizontal bite of the dermis

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 (again taking a horizontal bite of dermis)

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 (tie the suture to itself) or the ends left exposed and secured with steri-strips

Skin glue or steri-strips can be used on top of the wound for further wound protection

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

There are many, many other suture techniques, try to see as many as possible during surgical attachments/jobs to become familiar with a variety of techniques

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