COLLEGE OF VETERINARY MEDICINE & BIOMEDICAL SCIENCES

(Department of Clinical and Population Health)

VSUR 50
Principles of Veterinary Surgery and Anesthesiology

Exercise 7: Suture Patterns for Soft Tissues, Hollow Organs and Tendons
Learning Objectives:
● Demonstrate different suture patterns for the soft tissues, hollow organs and tendons
● Evaluate the quality of sutures.

Procedures Completion

1 Cushing suture

2 Lembert suture

3 Connell suture

4 Parker-Kerr suture

5 Halsted suture

6 Mayo mattress suture

7 Bunnell suture

Choice of Suture Materials

● Muscle: synthetic absorbable or nonabsorbable sutures
● Cardiac muscles: nylon and polypropylene - recommended based on mechanical properties
● Viscera: surgical gut, PGA, polyglactin 910 and monofilament non-absorbable suture
● PGA - not ideal for urinary bladder because it is prematurely absorbed in urine
● Polypropylene - choice in vascular repair because it is the least thrombogenic suture
● Peripheral nerve: nylon and polypropylene
● Tendon: nylon and stainless steel; PDS may also be effective - because of its prolonged tensile
strength
● Small bone fragments: monofilament stainless steel wire

Cushing or Gambee suture

● Useful in intestinal anastomoses in which a single-layer interrupted closure is desired
● Allows good apposition of viscera with large lumen size
● Pass the suture from the serosa through the muscularis and mucosa to the lumen on one side of
the incision
● Return the suture from the lumen through the mucosa to the muscularis on the same side of the
incision and let it cross the incision or site of anastomosis
● Introduce the needle in the muscularis on the opposite side of the incision and continue through
the mucosa to the lumen.
● Reintroduce the needle on the same side through the mucosa, muscularis and serosa to exit at
the external surface.
● Tie the ends lightly so that the suture impresses itself on the bowel surface.

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 COLLEGE OF VETERINARY MEDICINE & BIOMEDICAL SCIENCES
(Department of Clinical and Population Health)

VSUR 50
Principles of Veterinary Surgery and Anesthesiology

Lembert suture
● Continuous
● Inverting
● more effect on the local blood supply than a simple
continuous
● Used primarily to close hollow organs that require
inversion and a firm mattress pattern upon closure
● Procedure
○ Pass the suture from the serosa through
the muscularis and return through the
muscularis and serosa to the external
surface on the same side of the incision
○ Pass the needle across the incision to the
contralateral side and introduce it through
the serosa and muscularis at a point
corresponding to the exit point of the
suture on the opposite side.
○ Continue the suture in the reverse direction
through the same layers to exit to the
external surface distant to the incision
○ Tie the ends together and cut only the
short end of the suture
○ Advance the needle and repeat the vertical
mattress pattern in the same direction as
the first passage until the entire incision is
covered.
● Bites run perpendicular (Transverse -LemberT)
● penetrate the serosa, muscularis and submucosa but not the mucosa of the hollow organ
● The farther the bites are placed from the incision’s edge, the more tissue inverted.
● tension is adjusted with each bite as it is difficult to readjust once the pattern is completed

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 COLLEGE OF VETERINARY MEDICINE & BIOMEDICAL SCIENCES
(Department of Clinical and Population Health)

VSUR 50
Principles of Veterinary Surgery and Anesthesiology
Halsted suture
● Interrupted, inverting vertical mattress suture
● Used to close hollow organs
● It is a Lembert suture with only two parallel but reversing passages through the tissue
● Procedure
○ Place a vertical mattress suture through the serosa and muscularis layers of the hollow
organ similar to that of the Lembert suture.
○ Continue the suture by passing the needle parallel to and in the opposite direction as the
first tissue passage.
○ Tie the suture ends.

Connell suture
● continuous , inverting horizontal mattress
suture
● Used to close hollow organs
● It penetrates the lumen of the organ that is being sutured.
● Procedure
○ Begin the suture with a single
inverting vertical mattress
suture that incorporates all
the layers of the organ wall.
○ Tie the ends together and cut
only the short end of the
suture.
○ From the point of exit,
advance the needle parallel
to the incision and introduce it
into the serosa, passing
through the muscularis and
mucosa layers and extending
into the lumen.
○ From the lumen, advance the needle further along the and still parallel to the incision and
return through the mucosa, muscularis and serosa on the same side of the incision.
○ Once outside the viscera, apass the needle and suture across the incision, running
perpendicular to it, and introduce at a point corresponding (in distance from incision) to
the exit point on the contralateral side.

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 COLLEGE OF VETERINARY MEDICINE & BIOMEDICAL SCIENCES
(Department of Clinical and Population Health)

VSUR 50
Principles of Veterinary Surgery and Anesthesiology
○ Reinsert the needle through the serosa, muscularis and mucosa, advance it within the
lumen parallel to the incision and exit again to the external surface.
○ When tightened, you should be able to see the visible portions of the suture running
perpendicular to the incision line.
○ Do not tie the suture until the incision is completely stitched.

Parker-Kerr suture
● Double inverting suture of a single layer of Cushing
pattern covered by a layer of lembert pattern
● It is used to close the stumps of hollow organs.
● It is particularly useful in closing infection uterine
stumps.
● Prior to applying the first layer of suture, grasp the
stump with Rochester-Carmalt forceps.
● Replace the Cushing pattern over the forceps. Do not
tie the suture.
● Pull the suture in both directions while the Carmalt
forceps are being withdrawn. This permits inversion of
the stump without opening the lumen, thereby
preventing contamination and any loss of contents.
● Continue the suture with a second layer of Lembert
pattern. Tie the suture to the short end located at the
beginning of the first layer.

Mayo Mattress suture

● Overlapping interrupted mattress pattern
● Useful in midline abdominal closure in large animals and repair of abdominal hernia defects and
clefts of the secondary palate
● Procedure
○ Begin the suture by passing the needle from the outside to the inside of the incision on
one side.
○ Similarly, insert the needle on the opposite side on the same transverse plane in the
same inward direction.
○ Advance the needle 0.7-1,5 cm and pass it from within to the outside on the second
sutured side.
○ Return the needle
to the original
side passing it
from within to the
exterior in the
same transverse
plane.
○ As you tie the
knot, the first area
of tissue sutured

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 COLLEGE OF VETERINARY MEDICINE & BIOMEDICAL SCIENCES
(Department of Clinical and Population Health)

VSUR 50
Principles of Veterinary Surgery and Anesthesiology
will overlap the second.

Suture patterns for Tendons and Bones

Bunnell suture
● Insert the suture at the cut edge of the tendon and direct it diagonally toward the opposite side.
Let the suture exit on this side.
● Cross the suture superficially and perpendicular to the long axis of the tendon and bring it back to
the side of origin. Insert the needle on this side and pass the suture parallel to the original stitch.
● On exiting from the tendon, cross the suture again superficially and perpendicular to the long axis
and reintroduce on the side of origin, thus time, direct the suture retrograde toward the cut edge
in a diagonal pattern, passing approximately perpendicular to the previous passages through the
tendon, exiting where the first passage exited.

● Cross the suture again superficially and perpendicular to the long axis
of the tendon and reinsert parallel to the previous returning suture,
exiting at the cut edge of the tendon.
● Apply a similar pattern to the opposite end of the tendon and join the
two suture patterns by tying the matching ends of each pattern.
● In this pattern, you create a double figure X in each suture that passes
through the tendon. You may shorten the BUnnell suture to one X
pattern if the tendon is short.

Cerclage
● Implies that the suture is placed around the bone fragments
circumferentially
● Full cerclage is used where the length of the fracture is at least twice
the diameter of the bone.
● Two wires are placed at least 1 cm apart or more than 5 mm from the fracture ends.
● Apply wires with a wire tightener for absolute stability
● Only single loop wires should be applied
● Wire adjacent bones, such as radius and ulna, separately.