Advanced Suturing

Techniques

Bucky Boaz, ARNP-C

Subcutaneous Stitch
Deeper wounds or
wounds under tension.
Inverted knot.
Begin at bottom of
wound edge and come
up.
Go straight across
incision and down.
Running Stitch
Indicated for low risk
repairs.
Tie knot at one end, do
not cut until repair
complete.
Faster technique.
Plastic surgery quality.
Running Locked Stitch
Modified running
stitch.
Used to prevent
slippage of loops as
running stitch
continues.
Allows for continuing
stitch along irregular
laceration.
Vertical Mattress Stitch
Promotes eversion of
the skin.
Tension or very thick
skin.
Enter wound on one
side, pierce other side
twice, and exit on side
entered.
Horizontal Mattress Stitch
Needle is introduced
in normal fashion.
Second bite is placed
½ cm adjacent to exit
site.
Brought back next to
original insertion.
Tie knot.
Intracuticular running suture
Used to close linear
wounds that are not under
much tension.
Yields an excellent
cosmetic result.
The ends of the suture do
not need to be tied.
Taping under slight
tension will preserve
approximation.
Three-point or half-buried
mattress suture
Closure of the acute
corner of a laceration
without impairing
blood flow to the tip.
Three-point or half-buried
mattress suture
Needle is inserted into
nonflap portion of the
wound at the mid-dermis
level; and then at the same
level, the suture is passed
transversely through the
tip and returned on the
opposite side of the
wound paralleling the
point of entrance.
Three-point or half-buried
mattress suture
The suture is tied,
drawing the tip snugly
into place in good
opposition. This same
approach can be
utilized in closing a
stellate 4- or 5-point
laceration, drawing the
tips together in a
purse-string fashion.
Parallel Lacerations
The horizontal
technique is used to
cross all lacerations
Wound tapes can be
used if low tension
If island in middle is
wide enough,
interrupted sutures can
be used
Special Anatomic Sites
Extramarginal Lid Lacerations
Upper lid lacerations
are usually closed with
simple interrupted
Intramarginal lid
lacerations are best left
to plastics
Eyebrow lacerations
Most eyebrow
lacerations can be
closed without tissue
debridement
If devitalized, excise
tissue parallel to hair
shaft
Ear
72-hr window to drain
perichondral
hematoma
Simple
noncartilaginous
lacerations are closed
with interrupted or
running sutures
Lacerations involving
cartilage
Lip
Must approximate
vermilion border
Through and through
lacerations involve
orbicularis oris muscle
Repair muscle first
Then, vermillion
border
Then, rest
Questions?