Suture Techniques

1.Simple interrupted sutures

This can be either:

• Simple Interrupted
  • Used on majority of wounds
  • Each stitch is independent

Needle insertion

Instrument tying

2. Vertical vs Horizontal Mattress sutures

Vertical mattress

Horizontal mattress

Vertical Mattress – Useful for everting skin edges “Far-far-near-near”

Horizontal Mattress – Useful for single-layer closure of lacerations under tension

3. V-shaped wound closure

V-Shaped Repair

How do you Hand tie?

Hand tying first throw first knot

Hand tying second throw first knot

Hand tying second knot

Knot completion (This is done by alternating between the first and second knots)

Hand tying with suture

Aftercare

Dressings/ Surveillance for complications

• Consider splinting digits, joint surfaces
• Check tetanus status
• Pre-printed wound care instructions
• Pt must understand signs of infection

Once the scab has fallen off, massage and moisturize to reduce the risk of keloids and hypertrophic scar formation, this includes avoiding sun exposure, sunblock.

The district nurse or GP can follow simple, uncomplicated wounds for further wound care and suture removal.

Higher risk wounds must be reviewed earlier (24-48hrs), either at the ED clinic or respective speciality. Examples of high-risk injuries: hand wounds, Bites, heavily contaminated or wounds requiring antibiotics.

REMOVAL OF SUTURES

Anatomic Area	Days until Removal	External suture size	Buried Absorbable suture size
Face	4-5	5-0 or 6-0	5-0
Scalp	10-14	4-0, staples	3-0
Upper body	7-10	4-0	4-0
Hand	7-10	4-0 or 5-0	4-0
Lower body	10-14	4-0	3-0
Over joint (splint recommended)	14-21	4-0	3-0

Adapted from Face and scalp lacerations: timing for suture removal.¹⁰

• Physiotherapy and rehabilitation
  • Injuries with associated fracture
  • Injuries affecting joints
  • Injuries to special areas.