Suturing, commonly known as stitching, is a precise medical procedure performed by trained professionals to close a laceration. It holds the edges of a wound together, providing mechanical support while the body’s natural healing processes take effect. The primary purpose of closure is twofold: to speed up tissue regeneration by aligning the layers and to minimize the visibility of the resulting scar. A well-closed wound significantly reduces the risk of infection by preventing environmental contaminants from entering the deeper tissues.
Initial Assessment and Preparation of the Laceration
Before suturing, the medical professional must thoroughly assess the injury, starting with controlling active bleeding to allow a clear view of the wound bed. The initial evaluation determines the laceration’s location, depth, and degree of contamination. It is important to check for damage to underlying structures, such as tendons, nerves, or blood vessels, which may require specialized repair techniques.
Pain control is achieved using a local anesthetic like lidocaine, often injected around the periphery of the wound. This temporarily numbs the nerve endings, ensuring patient comfort during preparation and closure.
Once the area is numb, the wound must be meticulously cleaned through irrigation, where sterile saline or clean tap water is flushed under pressure to remove foreign debris and reduce the bacterial load. This cleansing prevents infection and is often done using a syringe and catheter to achieve optimal pressure.
Any nonviable, crushed, or damaged tissue must be carefully removed in a process called debridement, ensuring only healthy tissue remains. This preparation is necessary because clean edges approximate better, leading to optimal healing and a less noticeable scar. The skin edges are then dried and prepared for the application of the suture material.
Essential Instruments and Suture Materials
The standard instruments for laceration repair include specialized tools. The needle holder, or needle driver, is used to securely grasp the curved needle and drive it through the tissue layers. Toothed forceps, also known as pickups, stabilize and manipulate the skin edges, allowing precise alignment as the needle passes through.
Fine suture scissors are used to cut the thread after a knot is secured. The choice of suture material depends on the layer being closed and the amount of tension on the wound. Absorbable threads, such as polyglycolic acid, are used for deep layers beneath the skin because they dissolve harmlessly over time and do not require removal.
Non-absorbable materials, like nylon or polypropylene, are used for the outer skin layer and must be manually removed later. These materials are categorized by structure: monofilament threads are a single strand that slides smoothly, while braided threads offer superior knot security. Suture size is selected based on location; for instance, a finer 5-0 or 6-0 thread is chosen for the face to minimize scarring, while a thicker 4-0 thread is suitable for the extremities or trunk.
Core Suture Application Techniques
Suturing involves using the needle holder to drive the curved needle through the tissue layers, following the natural curve by rotating the wrist. For a good cosmetic result, the needle is inserted perpendicular to the skin surface, forcing the wound edges to slightly evert. Eversion is desirable because it helps prevent the final scar from sinking below the surrounding skin level.
The most common method is the Simple Interrupted technique, where each stitch is placed individually, tied off with a surgical knot, and cut. This technique offers the greatest security and allows control over tension; if one stitch fails, the others remain intact.
For longer, linear lacerations not under significant tension, a Continuous or Running suture may be used, involving a single thread running the entire length of the wound. This method is faster to place than interrupted sutures, but if the thread breaks, the entire closure can fail. The Running Subcuticular suture closes the layer just beneath the skin, running horizontally within the dermis. This hidden stitch provides support, reduces surface tension, and is useful in cosmetically sensitive areas as it leaves no visible stitch marks.
Techniques like the Vertical Mattress suture are employed when the wound is under high tension or requires superior edge eversion. This stitch involves a deep, wide bite followed by a shallow, narrow bite, effectively distributing tension deep within the wound. The choice of technique is guided by the laceration’s characteristics, including depth, location, and underlying tissue tension.
Post-Procedure Care and Suture Removal
Once suturing is complete, the wound is cleaned and a sterile dressing is applied to protect the site from contamination. The patient must keep the wound clean and dry for the first 24 to 48 hours. After this period, brief washing with mild soap and water is permissible, but soaking the wound in a bath or swimming is restricted until the stitches are removed.
Patients are educated on recognizing signs of infection, including increasing redness, localized swelling, pain, or discharge. The timeline for suture removal depends on the anatomical location, as different areas of the body heal at varying speeds.
Suture removal times vary significantly based on location:
- Sutures on the face, which has a rich blood supply, are typically removed earliest (three to five days) to minimize scarring.
- Stitches on the trunk are usually kept in place for seven to ten days.
- Wounds on the extremities or over joints, which experience more movement and tension, require a longer healing period (ten to fourteen days).
After sutures are removed, adhesive strips (Steri-Strips) are sometimes applied across the wound to provide continued support to the healing tissue.