Wound closure techniques have evolved from the earliest development of suturing materials to comprise resources that include synthetic sutures, absorbables, staples, tapes, and adhesive compounds. The engineering of sutures in synthetic material along with standardization of traditional materials (eg, catgut, silk) has made for superior aesthetic results. Similarly, the creation of topical skin adhesives (the monomer 2-octyl cyanoacrylate), surgical staples, and tapes to substitute for sutures has supplemented the armamentarium of wound closure techniques. Aesthetic closure of a wound, whether traumatic or surgically induced, is based on knowledge of healing mechanisms and skin anatomy (see the image below), as well as an appreciation of suture material and closure technique. Choosing the proper materials and wound closure technique ensures optimal healing. this is a brief study on different suturing techniques and tools used please comment thank u

1. Procedure
for Suturing
Wounds or
Hecting
Actions
PREPARED BY
MARTIN SHAJI
PHARM D

2. I. TOOL PREPARATION:
Ø Sterile gloves
Ø Duk the hole
Ø Minor surgical tool set
Ø Sewing thread
Ø Sewing needle
Ø Gauze sterile
Ø Normal saline fluid (Nacl 0.9%)
Ø Antiseptic liquid
Ø Potatoes sterile and place
Ø base
Ø Aesthetic drugs
Ø Plaster
Ø Plaster scissors
Ø Kom sterile
Ø Medical trash
Ø Disposable syringe
Ø H2O2 / Perhidrol solution
Ø Aprons
Ø Masks
Ø Trolley

3. II. PROCEDURE / HOW TO WORK
Ø Wash hands and dry, then wear sterile gloves
Ø Prepare tools
Ø Clean the wound using an antiseptic solution
Ø Replace gloves with other sterile gloves
Ø The tissue around the wound is anesthetized
Ø If necessary, clean the wound with normal saline (Nacl 0.9%)
Ø If the wound is dirty and use a solution of H2 O2 / perl hydrol 10%
Ø Install the hole duk
Ø Use a needle to sew the skin, insert the thread into the needle hole, using a
curved needle from the inside out.

4. Ø Hold the needle by using the clamp, then start sewing the wound.
Ø if the wound is deep to the muscle tissue, then sew it layer by layer (the
type of thread is adjusted to the torn tissue, for example: catgut, chromic,
side, etc.)
Ø Tie the thread by forming a knot.
Ø Cut thread, leaving 1mm length (for inner stitch), 0.65cm (outer stitch)
Ø Continue sewing the wound until the wound is closed.
Ø Apply normal saline / disinfectant to the stitches.
Ø Cover with sterile gauze.
Ø Install plaster / hypafix

5. III TERMINATION
Ø End the procedure well
Ø Asking the patient's response
Ø Cleaning tools (washing tools and re-sterilizing)
Ø Wash hands
Ø Thank the patient / family for the cooperation.
New wounds that have not entered Frederich's contamination time (6 - 8 hours
post trauma) can be treated primarily by cleaning the wound and the surrounding
field, removing debris and dirt and suturing the wound completely, while those
that exceed the contamination time can be cleaned of the wound and the area.
around the wound, straightening the wound and temporary suturing or the
situation. Wound suturing requires knowledge of wound healing, tools and
materials for sewing and most importantly, mastering suture techniques.

6. Wound (Vulnus)
Wounds are anatomical damage due to loss of tissue continuity due to
external causes. Wounds are divided into two: open wounds (Vulnus
Appertum) and closed wounds (Vulnus Occlusum).Types of open wounds:
Scissum, Puncture (Ictum), Burn (Combustio), Blisters (Excoriation /
Abrasion), Shoot (Sclopetum), Laceration, Penetration, Avulsion, Open
Fracture and Bite Wounds (Vulnus Morsum).
Types of closed wounds:
Bruises (Contusio), Bullae, Hematoma, Sprain,
Dislocation, Close Fracture, Laceration of internal organs.

7. Disinfection (Syn. Antiseptic or Germicide)
Is an action to free bacteria from the operating field, in this case, the
wound and its surroundings.Kinds of disinfection materials: Alcohol 70%,
Betadine 10%, Perhidrol 3%, Savlon (Cefrimid + Chlorhexidine), Hibiscrub
(Chlorhexidine 4%)Technique: Disinfect around the wound with gauze
soaked in disinfectantCover with a sterile doek or sterile gauzeIf
necessary, Lido / Xylo anesthesia is 0.5-1%

8. Wound Cleaning
Is washing the wound
Materials used: Perhidrol, Savlon, Boor water, Normal Saline, PZRinse with faali
salt or boor water Debridement (Wound Excision)Is to remove dead tissue and
smooth the edges of the wound Cut using a scalpel or scissors Treat bleeding by
ligating with gut paint Bleeding Treatment Is an action to stop the bleeding
process Namely by local compression or ligation of blood vessels or tissues
around the bleeding Suturing the wound Suturing the wound requires some
preparation, including tools, materials, and some other equipment. The
technical sequence must also be understood by the operator and his assistant.
Tools, materials and equipment needed

9. Tools needed:
Naald Voeder (Needle Holder) or needle holder is usually one piece.
Chirrurgis Tweezers or Surgical tweezers one piece
Cut one thread.
Sewing needles, depending on the size, just two pieces.
Materials needed :Seide or silk sewing thread
Sewing Thread Chromic and plain gut paint .Etc :
Doek a sterile hole
Sterile gauze
Handscoon sterile
Engineering operations

10. Suture techniques
1. Preparation of tools and materials
2. Preparation of assistants and operators
3. Disinfection of the operating field
4. Field operation anesthesia
5. debridement and excision of wound edges
6. suturing the wound
7. wound care suturing the blood vessels and intestines.

11. Local Anesthesia
For local anesthesia, 1% lidocaine is used in combination with epinephrine in a
ratio of 1: 100000. This lidocaine effect lasts about 1─2 hours. Together with
epinephrine, the effects of lidocaine can have a duration of up to 2─4 hours.
Due to the vasoconstrictive effect of epinephrine, it provides the following
advantages: Helps the anesthesia around the wound so it can last longer
Increases hemostasis around the wound
Slows down the absorption of the anesthetic lidocaine, thereby prolonging the
procedure
Sodium bicarbonate can be added to the local anesthetic mixture mentioned
above, to reduce the burning sensation at the time of inflammation of injection
.

12. If the hechting procedure takes a longer time, bupivacaine, 0.25–0.5%,
with or without epinephrine can be used. The effect of bupivacaine lasts
about 4─8 hours. Together with epinephrine, bupivacaine provides a long
anesthetic effect of up to 8─16 hours.
By paying attention to the side effects of anesthetics, it should be given to
the patient by taking into account the dosage according to body weight,
whether the patient is pregnant, breastfeeding, and the assurance of
normal liver and kidney function.
Position of the Patient
Depending on the location of the wound, the patient may lie in a supine
position, with both arms and hands resting at the sides. Position the
patient as comfortable as possible, without ruling out suturing the wound

13. Procedure
The most important thing to note in skin suturing is the correct closure of
the wound edges. In general, superficial wound closure is performed using a
single-layer technique. In some situations, where the wound is deeper, it
may require several layers of suturing using the appropriate type of needle
and thread. Pay attention when closing the wound so that it is not too tight.
Make sure that the wound is closed, there is no tunneling or undermining,
and that hemostasis has occurred correctly.
Simple Skin Suture, or Simple Interrupted Suture

14. This technique is the most basic technique in surgical wound closure
with suturing. The needle is inserted at a 90o angle of about 1─2 mm
near the edge of the wound to the subcutaneous tissue, or dermis. Then
the needle is directed towards the opposite side of the wound,
penetrating the exit tissue towards the skin surface of the opposite side,
giving an equidistant result between the entry point and the exit point.
Penetration into the dermis / subcutaneous tissue that is deeper than
the distance / width of the two points, will provide an "eversion edge"
on the suture surface, which is desirable. Make a knot, and cut out
afterward. Repeat stitching until the wound is closed, and the knot is
placed on the same side

15. - Single knots are carried out with absorbable threads with a distance of 1cm.
- The knot is placed on the edge of the wound in one of the puncture sites
- The thread is cut approximately 1 cm.
- The advantages of this technique are:
It didn't take long It can be used to cover all types of wounds with satisfying
cosmetic results The wound is divided in two, to prevent it, the excess tissue
between the wound edges
Stitches using this technique are done as little as possible to reduce the
inflammatory effect of the suture material used. Stitches should not be too
tight, not strangulated, because the wound edges only need to touch each other
to start the primary healing process. Stitches that are too tight will interfere with
blood circulation, cause necrosis, tissue scar, and cosmetically it will be bad. In
addition, a wound that has been sutured, even with a good technique, will cause
edema, so that over time, the stitches can be tense.

16. Simple Running Suture
This method is almost the same as the simple suture technique, only
without knots after the first stitch. The knot is made at the first stitch
and the last stitch. The speed at which this technique is performed
properly and correctly shows the skillful quality of the operator.
The advantages of this technique:
Helps hemostasis
Reduces the possibility of water ingress
The thread is easy to lift

17. The disadvantage of this technique is that if the suture is too tight, it can
cause strangulation of the surrounding tissue, including blood vessels.
Vertical Mattress
This technique makes it easy to form the "eversion edge" of the suture
on the surface of the skin. The suture can penetrate deeper through the
dermal layer, or even sub dermal. The knot is made on the surface of the
skin

18. The advantages of this technique:
Reducing dead space
Minimizes stress in the wound area
The disadvantage of this technique is that it requires a relatively longer
time. If you are not skilled at this technique, the end result of suturing will
form an "inversion edge", stress the wound, and increase the risk of scar
tissue formation.

19. Horizontal Mattress
This technique makes it easy to close wounds that have different tissue
thicknesses. The suture penetrates the subcutaneous, or dermal tissue to the
opposite side of the wound.
The advantages of this technique are:
Helps minimize tissue tension around the wound
Closing dead space
Helps form an "eversion edge" at the surface suture of the skin
The disadvantage of this technique that it can cause tissue strangulation,
resulting in hypoxia, necrosis, and delayed healing.

20. Subcuticular Skin Suture
The thread can be placed intra dermal, the simple way, or the running method.
Knots are made by implanting using simple suture technique.
In the running method, the final stitch can be made without knots, but by
attaching the end of the thread to the surface of the skin.
Sewing in children should use absorbable threads, so that there is no need for
thread extraction.
If the suture is planned to be in place longer, then a non-absorbable type, such
as nylon is preferred. The advantages of this technique are: Minimizes stress
on the wound edges
The running method is useful for more satisfying cosmetic healing

21. Cover or bandage the wound
After the wound is sewn neatly, clean it with a disinfectant (apply ointment)
Cover the wound with sterile gauze moistened with betadine
Attach it with plaster or hypafix (if necessary tied with Verban)
Remove Stitches Is the process of taking threads on the wound By location and
day of action:
¨ Face or neck day 5
¨ Stomach on day 7-10
¨ The palm 10
¨ Fingers day 10
¨ Upper limb day 10
¨ Lower limbs 10-14
¨ Chest day 7
¨ Back day 10-14📝