Suture Materials

Suture Patterns

Suture patterns are commonly classified as follows:

• Appositional; these sutures hold the tissue in place in the normal anatomical alignment, such as with skin sutures.
• Inversion; these turn the edges of the wound inwards, for example when repairing intestinal anastamoses.
• Everting; these turn the edges of the wound outwards, and are useful to counteract sites where inversion of a wound may spontaneously occur, such as deep lacerations. In this situation an occasional everting sutures within a line of appositional sutures is useful.

Suture patterns are also commonly described according to the style of insertion. A few of the more common patterns are described below:

Simple Interrupted

This pattern apposes the wound edges with single sutures, knotted with square knots and 4 throws per knot for this style of suture. The advantages of this style of suture are that tension can be adjusted per suture, and if one suture fails, the damage is less likely to be catastrophic. The disadvantages of this style of closure are time and the amount of suture material required.

Simple Continuous

This pattern is also an appositional pattern, where the suture material is knotted only at the beginning and end of the suture. The advantage of this technique is the reduced amount of suture material in contact with the wound, and an even tension is achieved along the wound. Use 5 throws at the start of the suture and 6 throws to finish.

Horizontal mattress

Mattress style sutures have an everting pattern and are usually applied as single interrupted sutures with the knot placed away from the wound edge.

Vertical Mattress

There are many other styles of suture pattern used for specific surgeries such as orthopaedics.

Suture Placement Practicalities

If you are right handed, close the wound from top to bottom or from right to left. If you are left handed, close the wound from top to bottom or from left to right. Drive the needle through the tissue by facing it away from your body and towards the wound, keeping the needle holder between your body and the wound at all times. To appose the tissue edges take separate bites from each side of the wound. Only ever handle the ends of suture material with surgical instruments as you will reduce the tensile strength in areas that have been handled by instruments.

Do not tie your sutures too tightly, as post op swelling can cause the sutures to ligate the tissue if they have been tied too tightly. Slide the knot away from the wound once you have tied it to reduce irritation to tissues post operatively. If, when you are placing sutures you discover that there is significant tension on the wound edges, a second deeper layer of closure is needed.