The Basics of Suturing: Pre-workshop

Learning how to suture is crucial for students who aspire to become surgeons. Suturing is a fundamental surgical technique that involves stitching together tissues in order to promote healing and prevent infection. By mastering this technique, students can hone their surgical skills and prepare themselves for the demands of a career in surgery.

Additionally, suturing requires high precision and attention to detail, which are critical traits for any aspiring surgeon. By practicing suturing, students can develop the dexterity and hand-eye coordination necessary to perform delicate surgical procedures with precision and accuracy.

Goals of Suturing:

1. To bring together the edges of the wound and promote primary healing by keeping them in contact.
2. To provide tensile strength to the wound and support the healing process until it develops its inherent strength.
3. To prevent the formation of dead spaces between wound layers, which can cause fluid buildup and delay healing.
4. To reduce the risk of bleeding, close off blood vessels in the wound.
5. To decrease the infection risk, reduce the wound’s exposed surface area and create a barrier to prevent bacteria from entering.

What You Need:

To learn how to suture, you must have certain materials at your disposal to be able to practice, such as:

• Suture pad
• Suture thread with needle
• Surgical tools
  • Adson forceps
  • Training Scissors
  • Needle holder

Types of Thread:

There exists two types of sutures: Absorbable and non-absorbable sutures.

• Absorbable: The enzymes found in the tissues of your body will naturally digest them. 
• Non-absorbable sutures: Need to be removed in the days or weeks following your procedure or may be left in permanently. 

How to Hold a Needle Holder

There are specific ways to hold the needle holder. However, the preferred way to hold it is called the tripod grip.

It is characterized by:

• Inserting the thumb and ring finger of your dominant hand into the rings of the needle holder. (Should only be the distal phalanges inside the ring)
• Placing the index finger over the joint to stabilize the needle holder. 

Grasping the Needle

To properly grasp the needle with the needle holder, grasp the needle approximately 2/3 along the length of the needle, perpendicular to the needle holder.

Once you’ve done that, press the ratchet lock on the handle to securely hold the needle in place. This will ensure you can work precisely and accurately while performing your task.

Types of Stitches:

Multiple types of suturing techniques exist that serve different purposes. Typically, you’ll see two variations of a suturing technique: interrupted and continuous sutures.

• Interrupted suture: Closes the wound where each stitch is separately tied.
• Continuous suture: Closes the wound with a single suture. Only the first and last stitches are fixed by knotting.

The Suturing Techniques We Will be Covering:

Simple Interrupted Stitch:

A simple interrupted stitch is a basic suturing technique where individual stitches are placed independently along the incision or wound. Each stitch is secured with a knot before moving on to the next, creating a series of separate and distinct points of closure.

This method allows for precise control over the tension and alignment of the wound edges, making it suitable for various types of incisions. Interrupted stitches are commonly used when a surgeon requires meticulous wound approximation and flexibility in adapting the stitch pattern to different tissue types or contours.

Simple Continous stitch:

A simple continuous stitch, also known as a running stitch or continuous suture, is a basic surgical stitching technique used to close wounds or incisions. This method is characterized by using a single, continuous thread to sew through the tissue continuously, creating a secure and consistent closure. The needle is passed through the tissue, and the suture is pulled through, forming a line of stitches without the need to tie individual knots between each stitch.

This technique is efficient and often used for closing long incisions or superficial wounds, providing a strong and even wound closure.

Vertical Mattress Stitch:

The vertical mattress stitch, also known as the “Donati stitch,” is a surgical suturing technique widely used to close wounds under high tension or when precise wound edge alignment is crucial. This technique involves passing the needle vertically through the tissue, creating a stitch that incorporates both deep and superficial layers of the wound.

The vertical mattress stitch is a highly effective method for distributing tension evenly across the wound edges, which helps to promote better wound approximation and reduces the risk of tissue strangulation. As a result, it is a valuable technique in areas prone to high tension, such as the skin over joints or where there is a need for strong support during the healing process.

Horizontal Mattress Stitch:

A horizontal mattress stitch involves passing the needle through the tissue parallel to the wound edges, creating horizontal bites on both sides. The stitches are placed at a distance from the wound’s edge, helping to distribute tension evenly and providing better wound approximation.

This technique is often preferred in areas where maintaining precise alignment of the tissue is crucial for optimal healing and cosmetic results. The horizontal mattress stitch offers increased strength and support, making it effective in securing wound edges in challenging anatomical locations.

To be Continued…

Be sure to attend the workshops to learn the different suturing techniques!