Suturing is used to close skin lacerations through the dermis. The basic steps for wound closure are hemostasis, local anesthesia, cleansing, creating a sterile field, choosing a closure method, and covering the wound. Suture selection depends on the location and depth of the wound. Common suture techniques include simple interrupted, horizontal mattress, two-step stitch, and vertical mattress sutures. Suture materials come in dissolving or non-dissolving varieties and different sizes are used for specific body areas.

1. SUTURING BASICS
When is skin closure needed? An open cut of the skin through the dermis (remember: Epidermis Dermis
Subcutaneous tissue Muscle)
What are the steps in wound closure? 1. Hemostasis 2. Local anesthesia 3. Cleanse 4. Sterile field 5.
Choose closure technique 6. Cover
How do you choose a closure method?
Instruments needed to suture: Pick-ups, scissors, suture
Helpful tips: Grasp forceps between thumb and middle finger, while index finger is used for stabilization.
Remember, your thumb and ring finger go into the needle holder’s rings (not your middle finger). Use tip of needle
holder to grab needed ~3/4 from tip. Your index finger stabilizers the neede holder.
Suture types: 2 types: Dissolving (monocryl, vicryl) & Non-dissolving (nylon, prolene)
Suture sizes: 0’s indicate size, more = smaller (e.g. 4-0= 0000 < 2-0= 00)
Sutures for different body parts: Scalp (4-0 or 5-0), Face,ear, nose, lip, forehead (6-0), eyelid (6-0 or 7-0),
Eyebrow (5-0 or 6-0), trunk/extremity (3-0, 4-0, 5-0), plantar foot (3-0, 4-0), hand (5-0)
Suturing techniques: The needle should enter the skin at a 90 degree right angle. The needle tip should be 2-3 mm away
from the laceration edge. Once penetrating the skin roll hand inward toward the laceration. The tip of the needle should cross
perpendicular across the laceration and exit out opposite side 2-3mm away from laceration skin edge.
Simple interrupted
Horizontal mattress: provides added strength in fascial closure; also useful for calloused skin
Two- step stitch: throw a simple stitch then, reverse the neede and make a
a second simple stitch made adjacent to the first with the same size bite.
Vertical mattress: nice for deeper lacerations. All the bites are in the same vertical plane.
References:
1.
Fleisher
&Ludwig.
Texbook
of
Pediatric
Emergency
Medicine.
2010.
Lippincott,
Williams,
and
Wilkins
2.
W ilson,
S.
Basic
Suturing
Lecture.
http://www.coadwi.org/Microsoft%20
PowerPoint%20-­‐
%20Basic%20Suturing%20Lecture%5
B1%5D.pdf
Accessed
7/29/12.