SYDNEY UNIVERSITY

SURGICAL SOCIETY

Introduction to Suturing & Wound Closure

Kilian Brown & Michael Seco

With thanks to Dr. Arridh Shashank (Past President)

Laceration repair
Wound healing
• Primary (first) intention
• Wound edges aligned, approximated & closed with sutures or
staples
• Low infection risk
• Minimal scarring
• Majority of surgical wounds
• Secondary intention
• Wound left open and heals “naturally” - granulation tissue fills the
void
• Elevated risk of infection
• Significant scar formation
• Tertiary intention (delayed primary closure)
• Wound left open for a number of days prior to closing
Langer’s lines
• Karl Langer (1819 – 1887)
• Maps the natural
orientation of collagen
fibers in skin
• Incisions are made
parallel to the tension lines
• Improved wound healing
• Less pronounced scar
formation
Local anaesthetic
• 1% lignocaine (Lidocaine) is
appropriate for most lacerations
• 1% lignocaine + adrenaline
• Reduces bleeding & extends duration
of local anaesthesia
• Contraindicated in regions with single
arterial supply e.g. nose – causes
end-artery constriction ➔ ischaemia
➔ necrosis
• Very dilute adrenaline (1/200,000)
can be used on digits
Classification of sutures
• Monofilament / Multifilament
• Absorbable / Non-absorbable
• Natural / Synthetic
• Size
Monofilament vs. multifilament

Monofilament Multifilament
Multiple strands of material are braided or
Single strand of material
twisted

Resists harboring microorganisms Rough surface can provide nidus for infection

More traumatic to tissue when handled

Smooth surface is less traumatic to tissue
improperly

Requires relatively more throws to secure Requires relatively fewer throws to secure

Braided: Vicryl, Surgilon, Ti Cron, Sofsilk,

Examples: Monocryl, Monosof, Prolene, PDS,
Polysorb, Silk
Maxon, Caprosyn, Biosyn, Novafil, Nylon
Twisted: Chromin gut, Cat gut
Absorbable vs. non-absorbable

Absorbable Non-absorbable
Natural absorbable sutures degraded & digested
Not degraded
by enzymes

Synthetic absorbable sutures are degraded by

Permanent in tissue
hydrolysis

Retain tensile strength (* except as marked

Loose tensile strength over time
below)

Examples: PDS, Vicryl, Monocryl, Polysorb, Examples: Prolene/Surgipro, Nylon, Steel, Ti

Maxon, Biosyn, Caprosyn, Cat gut, Chromic gut Cron, Silk*, Surgilon*, Monosof*, Dermalon*
Natural vs. synthetic

Natural Synthetic

Material from biological origin Synthetically derived polymers

Marked tissue inflammatory reaction Minimal tissue reaction

Examples: Ti Cron, Novafil, Surgipro, Surgidac,

Examples: Cat gut, Chromic, Silk Surgilon, Monosof, Vicryl, PDS, Monocryl,
Prolene, Nylon
Suture sizing
• United States Pharmacopoeia (USP) scale
• 11-0 (smallest) to 7 (largest)
• Human hair is approx. 6-0
• Face: use 6-0
• Body & limbs: use 3-0, 4-0, 5-0
Needle profile
Needle curve
Needle holders
ratchet
neck
needle grip

Mayo-Hegar
needle holders

Loaded on the shaft of

Loaded on the tip of
the needle, ⅔ of the
the needle holders
length from the point

90°
90°

90°
Needle holder handling

Traditional thumb-ring finger grip “Palming” - thenar eminence grip

Common forceps

Adson forceps DeBakey forceps

Gerald forceps Gilles forceps

Forceps handling
Simple interrupted suture
Simple interrupted suture
Continuous (running) suture

Diagonal part underneath the surface Diagonal part above the surface
Interlocking continuous suture
Horizontal mattress suture
Vertical mattress suture
Double loop suture
Subcuticular Suture
 Skills lab safety
• Must go in yellow sharps bin
• Be sensible
• No waving needles around
• Do not leave needles lying around
• ‘Shield’ needle if leaving unattended