General Tips to Better Technique


Grip swaged needles by the body and not by the swag to avoid needle damage.

suture spacingBites should be about 4-5 mm from wound edges. Sutures should be spaced about 5 to 7 mm apart, enough to approximate the wound edges but not so tight to cause ischemic skin edges.

Loose approximation of wounds produce stronger wound margins because proliferative activity can occur in the wound clefts, and proper wound edge alignment is encouraged.

Wound Pressure
Capillary wound pressure is the critical amount of suture force applied to the wound that will allow healing. When the force of the sutures exceeds the capillary wound pressure, the suture cuts into the tissue, the tissue becomes ischemic, loses strength, and linear fascial or skin tears develop. Too much suture pressure can cause fascial wound hernias and a poor cosmetic appearance.

fascial herniq
Example of incisional ventral hernia as result of wound healing complications.

Wound Closure When Strong Static Tension is Needed

meshRetention sutures were traditionally used to reduce the pressure on wound margins in wounds requiring strong static tension, i.e., wounds whose edges are retracted by 5 mm or more. But as would be expected, large sutures traversing the abdominal wall were often associated with wound complications. Now abdominal wounds requiring undue tension are often closed with prosthetic mesh and skin flaps. Image expands to 29K JPEG.

Knot Construction
The tensile strength of the suture material determines the number of throws for a knot.

General Guidelines

3 or more throws

Absorbable braided:
4 or more throws

(absorbable or nonabsorbable):
6 or more throws

handtieInstrument ties are appropriate for all wounds except when tension must be carefully adjusted. In those cases, hand ties are indicated. Image expands to 32K JPEG.

Good-bye for Now!

We've tied up all the loose ends on wound closure. Visit the Clinical Review site for the next issue when we target colectomy for study.

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