Sutures are placed on the area needed by mounting a needle with attached suture to a needle holder. The needle point which is sharp enough is pressed into the flesh, and it is advanced along the trajectory of the needle’s curve until it emerges on the other side. The trailing thread is then tied into a knot, commonly a square knot or surgeon’s knot. The knot is made in such a way that it should not cause blanching of the skin, since there may be a hindrance to the blood flow due to wrong suturing which may lead to enhanced infection and scarring.
The suture should be made in such a way that the skin of the wound should evert, and the depth and width of the sutured flesh should be approximately equal. The distance of each suture is based on “Jenkin’s Rule” which states that the required length of the surgical suture material for closure of a wound with interrupted stitches is four times the length of the wound, as each bite should be 1cm from the edge, and placed 1cm from the previous suture.
The “simple interrupted stitch” is the most common of many different techniques used in suturing. And it is named “interrupted” because the suture thread is cut between each individual stitch. This technique’s main disadvantage is time consuming. This is because placing and tying each thread separately consumes more time compared to other suturing techniques. On the contrary, important advantage is that it still keeps the wound together even if one surgical suture fails. The surgeon’s knots or knots cross the wounds perpendicularly and it is a simple procedure.
The other types in suturing include vertical and horizontal mattresses stitch. They are also interrupted, but are more complex and specialized for everting the skin as well as distributing the tension. The variations in the horizontal mattresses stitch include chest drain stitch and corner stitch. The continuous stitch as the name suggests are not interrupted unlike the other ones and it is a quicker stitch. But it may fail if the suture is cut in just one place. Nevertheless, in some ways continuous locking stitch is more secured compared to other ones. There is a circular, continuous inverting suture called Purse-ring suture, which is made to secure apposition of the edges of a surgical or traumatic wound. Other suturing techniques include Figure 8 stitch and Subcuticular stitch.
Suturing classified by layers are mainly two, namely single layer suturing and two layer suturing. Most of the suturing discussed above comes under single layer suturing. Two layer suturing involves suturing at a deeper seated or a deeper level of a tissue followed by another layer of suturing at a more superficial level. For instance, Cesarean section can be performed with single or double layer suturing of the uterine incision.
Some sutures are kept permanent at the wounded area and some are kept for a couple of weeks and are removed when the tissues are sutured well. Generally, tissues are kept for a short while, that is, it is a short term treatment method for a trauma or a wound. So removal is an important part of the suture treatment. Different parts of the body heal at different rates. So common time to remove stitches also varies. Facial wounds take about 3-5 days to heal while scalp wound takes about 7-10 days. Limbs and joints take about 10-14 and 14 days while the trunk of the body takes about 7-10 days.