When talking about simple laceration and wound suturing in emergencies, suturing and stitching are sometimes used interchangeably.
The word suture denotes the act of sewing by bringing tissues together and holding them until healing has taken place.
Suturing is the most preferred technique for laceration and incised wound repairs.
Suture are classified as absorbable such as polyglactin, chronic surgical cut and non-absorbable sutures such as virgin silk.
Silk sutures are no longer used to close the skin because of their poor tensile strength and high tissue reactivity.
A 3-0 or 4-0 suture is appropriate on the trunk
A 4-0 or 5-0 on the scalp, 5-0 or 6-0 on the face.
Blue colored suture this type of suture may be beneficial for scalp laceration in appropriate population to differentiate the suture from the hair.
Traditionally, suture begins a short distance before the edge of the wound, with the remaining stitches placed symmetrically until the wound is closed.
The Primary Goals of Simple Laceration and Wound Suturing in Emergencies
- To Close dead space
- Support and strengthen wounds until healing increase their tensil strength.
- Minimize the risk of excess bleeding and infection.
- Approximate skin edge for aesthetically pleasing and functional result.
Furthermore, during suturing you should check the interval between injury and the repair, the patients age and state of health, and degree of contamination, and potential for foreign bodies be embedded in the wound.
Method and Techniques In Suturing:
There are several suturing technique that exist, but interrupted sutures are generally used by the non-experienced person.
During interrupted suturing, if a single suture is placed incorrectly, it is easy to replace without disrupting the remaining suture.
Alternate sutures can be removed in facial wounds, where a good cosmetic effect is important.
Also in infected wound where it may be necessary to allow the dirnage of pus.
Suture removal is usually simple and less painful for patients.
Horizontal mattress technique: : this may be the best option for closing gap of high tension wounds or wounds on fragile skin, because it spreads the tension along the wounds edge.
Vertical mattress: for everything wound that ends in the area that tends to invert. E.g. posterior neck or concave skin surface.
Half buried mattress suture: this is ideal for the closure of a triangular edge, because it does not compromise the blood supply, theoretically decreasing tip necrosis.
The running (baseball ) suture: this suture is ideal for closing small laceration in low skin- tension areas where cosmetics is important, such as on the face.
And the end doesn’t need to be tied but can be secured with a clip knot or tape.
Hair apposition technique: this can be used for closing scalp wounds, it is best for non-actively bleeding wounds less than 10cm long, when scalp hair is longer that 3cm. this method can be performed by no physicians.
Tissue adhesives: this can be applied more quickly and requires no anesthesia and eliminate the need for follow ups, because they heal up in 5-10 days.
It is ideal for simple laceration, it should be avoided in areas that has moisture.
Stainless steel or absorbable staples and skin closure strips: this is ideal in repairing laceration.
Automatic staplers usually used in surgical wound repair are recommended for closing thick skin on the trunk and scalp but not face, neck, hands and feet.