Medical Suture Course

Future Doctors Network

 General information

Defini&on of wound:

A w o u n d i s a d e fe c t i n t h e p r o t e c 1 v e c o v e r i n g 1 s s u e a n d a d e s t r u c 1 o n o f 1 s s u e b y
external ac1on.

Prepara&on:

The environment in which wound care is carried out should be as trouble-free as possible. The
wound care should be carried out under asep1c condi1ons by means of sterile drapes,
bonnets, face masks, sterile gloves and handling of instruments.
Structure of the skin

Subcutis/Hypodermis
 Suture materials - thread
Thread structure:

Monofilament threads Polyfile threads

-Smooth, even surface -Pliable
-Optimum fabric passage -Good knotting properties
-Little sawing effect & Handling
-Good knot fit
-Free of cavities
-Little memory effect
-No capillarity
 Suture materials - thread
Resorption:

Resorption refers to the complete breakdown of the material in the body within a defined period of time.

Absorbable suture: Non-absorbable suture:

-Polygycolic acids (Vicryl, Dexon) -monofil (Prolene, Miralene, Ethilon, Seralon)

-Polydioxanone (PDS) -polyfil (Mersilene)

-Monocryl -Silk, twine (flax)

 Suture materials - thread
Thread strength:

The most widely used nomenclature for classifying filament thickness is the American
Pharmacopoeia USP. The European Pharmacopoeia is based on the metric system and
corresponds to 1/10 mm thread thickness. These size specificaCons are printed on
the packages of the sutures.
 Suture materials - thread

USP Metric mm

12-0 0.01 0.001–0.009 Trunk and extremities: 2-0 to 3-0

11-0 0.1 0.01–0.019 Face and fingers: 5-0
Children: 5-0
10-0 0.2 0.02–0.029

9-0 0.3 0.03–0.039

8-0 0.4 0.04–0.049 Subcutaneous suture: 2-0 to 3-0
7-0

6-0
0.5

0.7
0.05–0.069

0.07–0.099
Vascular ligations: 2-0
5-0 1 0.1–0.149 Muscle suture: 0-2
4-0

3-0
1.5

2
0.15–0.199

0.2–0.249
Fascia suture: 1-3
2-0 2.5 0.25–0.299 Vascular suture: 5-0 to 7-0
2-0 3 0.3–0.349
Nerve suture: 8-0 to 10-0
0 3.5 0.35–0.399

1 4 0.4–0.499 Eyes: 10-0 to 12-0 Neurosurgery

2 5 0.5–0.599
(microanastomoses cerebral vessels): 8-0 to 10-0
3 6 0.6–0.699

4 7 0.7–0.799

5 8 0.8–0.899
6 9 0.9–0.999
 Suture materials – needles
Needle type:

• Atraumatic: Thread sunk in needle shaft; without Oehr

• Traumatic: With Oehr

Round-body needle
Needle shape:

• Straight
• Curved: 1/4 circle, 3/8 circle, 1/2 circle, 5/8 circle

Cutting needle
Profile: Round, cutting, trocar, spatula, lancet
Length: Indication in mm (with bent needle stretched length)
 Suture techniques
Handling of the instruments:

• The tweezers are held like a fountain pen between the thumb, index and middle finger.
• The needle holder is moved with the end and middle phalanges of the thumb and ring finger of
the guide hand.
• Never posi?on the fingers up to the base phalanges in the instruments.
• The index finger is used to stabilize the instrument.
• The iden?cal handling also applies to scissors, overholds, etc.
 Suture techniques

Grasping the needle:

The needles are installed in the foremost area of the barrel surface of the needle holder in a direc1on
perpendicular to the axis of the instrument in the rearmost third of its curvature.
 Suture techniques
1) Single button suture:
Indication:
Closure of superficial, non-opening skin wounds

Procedure:
Suture material: e.g. Prolene
Both wound edges should be sufficiently grasped and the subcutis should be involved. The needle is
inserted perpendicular to the skin. The insertion and removal stitches must be the same distance from the
wound edge.
 Suture techniques
Single button suture:

For the knot, the needle holder is positioned between the two parts of the thread in the direction of the
wound.
 Suture techniques
Single bu/on suture:

Then the thread is looped twice around the front third of the needle holder and the short thread end is
grasped. The crossed 1ghtening of the thread takes place.
 Suture techniques
Single bu/on suture:

For the subsequent knots (4-5 x), the thread is looped around the needle holder only once. At the
end, the knot is moved to one side of the wound edge.
 Suture techniques
2) Suture according to Donati (back stitch suture):
Indication:
Wounds in body regions that are exposed to particularly strong tensile and shear forces (near joints,
on the back and abdomen, not in the facial region).

Procedure:
Suture material: e.g. Prolene
Deep penetration and removal comparable to the single button suture described above.
 Suture techniques
Suture according to Donati:

The back stitch is made vertically on the side of the stitching out and at the same distance from the wound
edge on both sides, which should be around 0.1 cm.
 Suture techniques
Suture according to Donati:

Knots as already described in the technique. Deep inser1on and removal are used to stabilize the
wound and intracutaneously for wound margin adapta1on.
 Suture techniques
Intradermal suture:
Indica.on: Adapta1on of wound edges with cosme1cally best results.

Procedure:
Suture material: e.g. Monocryl or Vicryl rapid.
Ini?al node: The ini1al knot of the intracutaneous suture is an inver1ng knot. For this purpose, the puncture side
in the subcu1s is s1tched from deep to superficial, while the opposite side is s1tched from superficial to deep. As a
result, the knot is pulled downwards.
 Suture techniques
Intradermal suture:

Subsequently, stitch from the subcutis to intracutaneous. Continue the suture intracutaneously in
a serpentine pattern.
 Suture techniques
Intradermal suture:

Terminal node: Stab into the subcutis and again to intracutaneous, leaving the loop long. Stitch into
the subcutis again. The suture is now tied with the loop left standing.Cut off the loop briefly.
 Suture techniques
Intradermal suture:

The puncture is made through the subcutis at a distance of approx. 1 cm from the wound. Cut
the thread at skin level. Additional securing with steristrip is possible.
 Alternative suture techniques
• Tissue adhesive (Dermabond) for minor wounds and children.

• Skin staples (Skin stapler) Indica1on: Very fast, cosme1cally equivalent.

• Adhesive strips (Steristrip) for smaller wounds and children.

• Metal clips for vascular liga1ons.

• Stapling and cu]ng devices (stapler) in endoscopic surgery, intes1nal surgery and
thoracic surgery.
Surgical hand knots
 Post treatment
Sterile dressing:

After completion of the suture, the wound is cleaned superficially with a compress. Do not use
any disinfectant here, as this can lead to wound healing problems. After cleaning, the wound is
covered with a plaster and a sterile dressing is applied with light pressure.
 Post treatment
More informa.on and tetanus vaccina.on:

• Refresh tetanus vaccine protec1on if needed!

Inform pa.ents about:

• Painkillers if needed (write prescrip1on if necessary)

• Repeat emergency presenta1on in case of: Redness, hyperthermia, swelling,

severe pain, secre1on, pus, fever or gaping wound.

• Leave the sterile dressing for 48 hours

• Carefully dab the wound dry a_er showering

• Refrain from sports in the following days (if necessary, even immobiliza1on)

• Appointment for suture removal

 Post treatment
Suture removal:

The guideline values differ depending on the location of the wound, age, general condition of the patient
and wound extent:

• Facial: 2nd-4th day

• Enoral: 1-3rd day
• Head/neck: 4th-6th day
• Trunk: 4th-8th day
• Extremities: 10th-14th day
 Post treatment
Procedure:

• Disinfect the wound prior to suture removal.

• Lift one end of the suture with the tweezers to lift the button from the skin.

• Using the tip of the scissors, cut the part of the suture that runs into the skin directly below the button.

• Then pull the thread out of the stitch canal in the direction of the former incision.

• After removing the suture, if necessary, provide sutures with steristrips or bandages.
 Attachement
Sources for pictures:
- https://www.fortbildung.usz.ch/lehre/Der-chirurgische-Wundverschluss.pdf
- https://docplayer.org/amp/11600660-Chirurgische-knotentechnik.html

Created by Lukas Arndt (Future Doctors Network)