Basic Sutures

Material

• Sterile fenestrated drape.
• Needle holder.
• Surgical scissors.
• Surgical tweezers.
• Anatomical tweezers.
• 1 reabsorbable suture with rounded needle for suturing deeper layers.
• Non-reabsorbable suture with a sharp needle for suturing the skin.
• Sterile gauze pads 10 ×10 cm.
• Disinfectants.
• Local anaesthetic.
• Bandage materials.
• Bandage scissors.

Laboratory Setting

Clinical Setting

Procedure

1. Ask the patient to lie down and tell them what you are about to do.
2. Ask the patient about allergies to iodine or local anaesthetics.
3. Adjust the lighting.
4. Disinfect the edges of the wound and the surrounding areas.
5. Put on sterile gloves.
6. Cover the wound with a sterile fenestrated drape.
7. Administer infiltration anaesthesia or guided anaesthesia using the Oberst method; wait until the anaesthesia takes effect.
8. Place the atraumatic needle in the small portion of the jaws of the needle holder, approximately halfway along the needle [Figure 18].
   Figure 18
9. Hold the surgical tweezers in a pencil grip [Figure 19] in one hand. In the other hand, take the needle holder [Figure 20].
   Figure 19
   Figure 20
10. Using the tweezers, grip the edge of the wound furthest from you; to minimise tissue damage, the side of the tweezers with one tooth should be placed in the wound margin and the side with two teeth should be placed in the skin.
11. Position the needle perpendicularly on the skin approximately 0.5 cm from the wound margin and insert through the skin [Figure 21].
    Figure 21
12. With a supinating hand motion, bring the needle through the wound margin in an arc, similar to the curve of the needle. For wounds that do not extend beyond the cutis and have no tension in the wound margins, proceed directly to Step 17. For deeper wounds, suturing in two stages (making a stitch from the wound margin to the center of the wound, then refastening the needle and completing the stitch from the wound center to the opposite wound marging) provides a better end result; see Step 13 [Figure 22].
    Figure 22
13. Open the needle holder and refasten it to the portion of the needle entering in the wound.
14. Pull the needle through the skin and out of the wound in a curved path.
15. Reposition the needle in the correct position in the needle holder.
16. Pull the thread through the skin, leaving a sufficient amount to be tied later (about 2 cm if tying with the needle holder or at least 10 cm if tying by hand).
17. Using the tweezers, grip the edge of the wound closest to you and turn the wound margin outward [Figure 23].
    Figure 23
18. With a curving motion, insert the needle into the wound margin bringing it as deep along the wound bed as possible, and continue through until the needle point appears through the skin [Figures 23, 24].
    Figure 24
19. Open the needle holder when it is adjacent to the wound margin and use it to grip the needle again on the outer side of the skin [Figure 25].
    Figure 25
20. Pull the needle in a curved path through the tissue using the tweezers to fixate the exiting point of the needle in the wound.
21. Using thumb and forefinger, grip the needle securely and open the needle holder.
22. Tie the thread in a knot with the aid of the needle holder.