Introduction
For a good end result, the following recommendations must be followed:
- Work atraumatically.
- Injure as little tissue as possible with the tweezers.
- Do not cauterise near the skin and use atraumatic suture material.
- Adapt the wound margins.
- Distances between the wound and the suture should remain equal (about 0.5 cm), and the distance between stitches should also remain equal.
- The suture must extend to the deepest part of the wound so that all layers of the cutis adapt.
- To avoid “dog-earing” with larger wounds, one or more positional stitches should be made in the middle first.
- Avoid ischaemia.
- For V- or T-shaped wounds, intracutaneous three-point stitches are made (a stitch directly through the skin flap can lead to necrosis).
- In some cases, the vulnerable skin flap can be kept in place with a suture strip [Figure 16].
Figure 16
- Avoid tension.
- For curved incisions, take larger steps on the outer side of the curve than on the inner side [Figure 17].
Figure 17
Wound margins that are already under some tension can be sutured using a Donati suture. The suture thread must not be pulled too tightly. This can have a negative effect on circulation (and therefore healing).
Removing Sutures
Single Suture
Donati Suture
Running Suture