Suturing, commonly known as stitching, is a medical procedure used to reapproximate the edges of a wound or incision. This technique holds tissues together, promoting natural healing, reducing infection risk, and minimizing visible scarring. Applying sutures is a skilled medical procedure requiring a sterile environment and training. It should only be performed by qualified healthcare professionals such as physicians, physician assistants, or nurses. This article details the principles and mechanics of wound closure for informational and educational purposes.
Preparing the Wound for Closure
Before closure, the wound must be thoroughly assessed and prepared for optimal healing. Assessment determines the wound’s depth, contamination level, and location, which influence the closure technique and timing. For contaminated wounds, closure is ideally performed within the “golden period,” often 6 to 8 hours after injury, to significantly reduce infection risk.
Proper wound cleansing is necessary to reduce the bacterial load and remove foreign debris. This involves high-volume irrigation, often using sterile normal saline solution delivered under pressure. The fluid force is key for decontamination but must be controlled to prevent tissue trauma or pushing bacteria deeper. While the surrounding skin is prepared with antiseptic solutions, these agents must be prevented from entering the wound bed, as they can impair tissue healing.
Achieving hemostasis, or the cessation of bleeding, is also a prerequisite for successful suturing. Persistent bleeding interferes with visualization and can lead to hematoma formation, increasing infection risk and compromising the cosmetic result. Once the wound is clean and bleeding is controlled, a local anesthetic is administered to ensure patient comfort before closure begins.
Essential Suturing Materials and Methods
The suturing procedure requires specific instruments for precise tissue handling. The needle driver (or needle holder) grasps and controls the curved surgical needle. Tissue forceps gently lift and stabilize the wound edges for accurate needle placement, and fine surgical scissors cut the suture material once the knot is secured.
Suture material is categorized as either absorbable or non-absorbable based on its fate in the body. Absorbable sutures (e.g., Poliglecaprone or Polydioxanone) are broken down by the body and do not require manual removal. They are suitable for deep layers or hard-to-reach areas. Non-absorbable sutures (e.g., Nylon or Polypropylene) maintain their strength indefinitely. They are typically used for skin closure or areas requiring permanent support, necessitating removal after healing.
Materials are also classified by structure as monofilament or multifilament (braided). Monofilament sutures consist of a single strand, passing through tissue with less friction and associated with a lower infection risk due to the smooth surface. Braided sutures, composed of multiple strands, offer superior handling and knot security. However, they can potentially harbor bacteria, making selection dependent on the specific wound and tissue type.
The Simple Interrupted Stitch is a common and versatile closure technique used for skin. The needle must enter the skin surface at a 90-degree angle, equidistant from the wound edge on both sides. It is driven through the tissue following its natural curvature, aiming for an exit point that mirrors the entry point.
A crucial goal is to achieve slight eversion, where the wound edges turn slightly outward. This outward rolling is accomplished by taking a wider and deeper bite of tissue than the final closure width. Eversion is structurally stronger and leads to a flatter, less noticeable scar than an inverted closure. The stitch is secured using an instrument tie to form a square knot, ensuring the tissue edges are gently approximated without excessive tension that could impair blood flow.
Managing the Sutured Wound
After successful closure, proper post-suture care is essential for preventing complications and facilitating optimal healing. The area is typically covered with a sterile dressing for protection and should be kept clean and dry, especially for the first 24 to 48 hours. Patients must avoid activities that place excessive strain or tension on the wound, which could lead to dehiscence (the wound opening up).
Close monitoring for localized signs of infection is standard during recovery. While mild redness and swelling are normal inflammatory responses, increasing pain, spreading redness, warmth, or purulent (pus-like) drainage may indicate infection. A fever within 48 hours of suturing is a significant concern requiring immediate medical evaluation.
Non-absorbable sutures must be removed once the wound has achieved sufficient tensile strength, which varies by body location. Face sutures, an area of low tension and high blood supply, are typically removed in 5 to 7 days to minimize “track marks.” Areas under higher tension, like the back or limbs, may require sutures to remain in place for 10 to 14 days or longer.
The removal technique involves cleaning the area and gently lifting the knot with forceps. The suture is cut with sterile scissors on the side closest to the skin entry point. This allows the suture to be pulled out through the least contaminated path, preventing the exposed portion from being pulled through the healing tissue.