This document discusses suturing techniques and materials. It begins by outlining the objectives of learning suturing instruments and closure techniques. Various instruments used for suturing like forceps and scissors are described. Different types of needles, suture materials both absorbable and non-absorbable, and whether they are monofilament or braided are explained. Basic suturing techniques like simple interrupted sutures, running sutures, and mattress sutures are outlined. Factors to consider when choosing a suturing technique based on wound type and location are highlighted. Principles of knot tying are reviewed.

1. NANDEESHA S.L

2. Objectives
 Recognize the proper instruments for suturing.
 Become familiar with different types of closure
techniques

3. Instruments
adison forcep hemostat metzenbaum scissors suture scissors
adson forceps hemostat metzenbaum scissors suture scissors
Thumb forceps

4. Instruments
Needle holders blade handle suture removal scissors bandage scissors
Needle holders suture removal scissors
blade handle

5. NEEDLE

6. Surgical Needle

7. Suture Material
• 3 ways of classifying suture material:
– Natural or Synthetic
– Absorbable or Non-Absorbable
– Monofilament or Braided/Twisted

8. Reading the Suture Label
•
Company
Needle
Size
Order Code
Name
Also:
LENGTH
NEEDLE
SYMBOL
COLOR
Absorbable
or Non

9. Silk
Catgut
• Natural
– Silk, linen, catgut
• Synthetic polymer
– Polypropylene,
polyester, polyamide
Polypropylene
Polyester

10. • Absorbable
– catgut, polydioxanone, polyglycolic acid
– Used for deep tissues, membranes, & subcuticular
skin closure
• Non-Absorbable
– polyester, nylon, stainless steel
– Used for skin (removed) & some deep structures
(tendons, vessels, nerve repairs – not removed)

11. • Monofilament
– Polypropylene
– Polydioxanone
– Nylon
• Multifilament
– Catgut (twisted)
– Polyester
– Silk (braided)

12. Principles of suturing
1. The needle is grasped with a needle holder at its 23
of its curvature .it never held by the eye or the point
2. The area to be sutured is dried with a sucker or
cotton swab so that the cut edge are clearly visible .
3. Suturing from the movable to the fixed wound
margin
4. Toothed dissecting tweezers are used to grip the flap
and fix it .

13. Contd…
5. The needle should pass at least 3 mm from the wound
margin
6. The knots should be lied at one side of the wound
margin.
7. The knots should be not too tight and not too loose .

14. Remember!!! Thumb & ring finger into needle holder’s rings (NOT your middle
finger!) Index finger stabilizes the instrument by resting on the shaft

16. THE CHOICE OF SUTURE TECHNIQUE
 Type and anatomic location of the wound
 Thickness of the tissue
 Degree of tension
 Desired cosmetic result in the case of skin

17. Closure Types
Primary closure (primary intention)
 Wound edges are brought together so that they are
adjacent to each other (re-approximated)
 Examples: well-repaired lacerations, well reduced bone
fractures.

18. Secondary closure (secondary intention)
 Wound is left open and closes naturally (granulation)
 Examples: Gingivectomy, Gingivoplasty, tooth
extraction sockets, poorly reduced fractures

19. Tertiary closure (delayed primary closure)
 Wound is left open for a number of days and then
closed if it is found to be clean
 Examples: healing of wounds by use of tissue grafts.

20. TYPES OF SUTURE
 Simple interrupted suture – most commonly used, good
for shallow wounds without edge tension

21. SIMPLE INTERRUPTED SUTURE

22.  Continuous suture (running sutures) – good for
haemostasis (scalp wounds) and long wounds with
minimal tension

23. Simple Running Suture

24.  Locking continuous - useful in wounds under
moderate tension or in those requiring additional
haemostasis because of oozing from the skin edges

25. Running-locked Suture

26. Contd…
 Subcuticular – good for cosmetic results

27. Running Subcuticular Suturing

28.  Vertical mattress – useful in maximizing wound
eversion, reducing dead space, and minimizing
tension across the wound

29. Vertical Mattress Suture

30.  Horizontal mattress – good for fragile skin and high
tension wounds

31. Horizontal Mattress Suture

32. Basic types of sutures
 Interrupted sutures: Simple interrupted suture
Vertical mattress suture
Horizontal mattress suture
 Running sutures: Simple running suture
Running-lock suture
Running intradermal suture
Running vertical mattress suture
Running horizontal mattress suture

33. OTHER
 Clips
 Staplers
 Wound closure without knotting
 Zip Line
 Adhesive strips

34. Staplers

35. Linear Staplers - GIT

36. Zip Line

37. Adhesive strips

38. March 23
38
GENERAL PRINCIPLES OF KNOT TYING
The knot must be as small as possible.
Final tension on final throw should be as
nearly horizontal as possible.
Ends should be cut as short as possible.
Sutures used for approximation should not be
tied too tightly.

40. PRACTICE OF THE SUTURES