Suture Techniques

• What is a taper-point needle?
  • Round body:
    • Leaves a round hole in tissue:
      • Spreads without cutting tissue
  • What is it used for?
    • Suturing of soft tissues other than skin:
      • For example:
        • GI tract, muscle, nerve, peritoneum, fascia

• What is a conventional cutting needle?
  • Triangular body with the sharp edge toward the inner circumference:
    • Leaves a triangular hole in tissue
  • What are its uses?
    • Suturing of skin

• What is a simple interrupted stitch?

• What is a vertical mattress stitch?
  • Simple stitch is made;
    • The needle is reversed, and a small bite is taken from each wound edge:
      • The knot ends up on one side of the wound
• What is the vertical mattress stitch also known as?
  • Far–far, near–near stitch:
    • Oriented perpendicular to wound
• What is it used for?
  • Difficult-to-approximate skin edges:
    • Everts tissue well

• What is a simple running (continuous) stitch?
  • Stitches made in succession without knotting each stitch

• What is a subcuticular stitch?
  • Stitch (usually running) placed just underneath the epidermis:
    • Can be either absorbable or non-absorbable:
      • Pull-out stitch if non-absorbable

• What is a purse-string suture?
  • Stitch that encircles a tube perforating a hollow viscus:
    • For example:
      • Jejunostomy tube
      • Gastrostomy tube:
        • Allowing the hole to be drawn tight and thus preventing leakage

• What are metallic skin staples?

• What is a staple removal device?

• What is a gastrointestinal anastomosis (GIA) device?
  • Stapling device that lays two rows of small staples in a hemostatic row:
    • And automatically cuts in between them

• What is a Lembert stitch?
  • It is a second layer in bowel anastomoses
  • Technique:
    • The needle is inserted perpendicular to the epidermis, approximately 8 mm distant to the wound edge.
    • With a fluid motion of the wrist, the needle is rotated superficially through the dermis, and the needle tip exits the skin 2 mm distant from the wound edge on the ipsilateral side.
    • The needle body is grasped with surgical forceps in the left hand and reloaded onto the needle driver.
    • The needle is then inserted perpendicular to the skin on the contralateral side of the wound edge, 2 mm distant from the wound edge.
    • The needle is again rotated superficially through its arc, exiting 8 mm from the incised wound edge.
    • The suture material is then tied off gently, with care being taken to minimize tension across the epidermis and avoid overly constricting the wound edges

• What is a Connell’s stitch?
  • The first mucosa-to-mucosa layer in an anastomosis:
    • Basically, a running U stitch
  • The Cushing and Connell suture technique:
    • Is often used to close the incisions in hollow organs such as the stomach, urinary bladder, and uterus
  • In the Cushing suture technique:
    • The suture penetrates into the submucosa without penetrating the organ lumen
    • The suture runs from both sides of the incision:
      • Parallel to each other
  • The Connell suture technique is almost identical to the Cushing suture technique:
    • These two suture techniques are separated according to the tissue they penetrate during suture passage
    • While the Cushing suture technique is also passed through the submucosa, Connell suture technique is used to pass through the lumen
  • While applying these techniques, the following steps are followed:
    • A directionally opposed suture passage is made parallel to the incision.
    • Suture passage is made from the other side of the incision in the same direction as the incision, parallel to the first passage
    • The beginning of the suture line is fixed with a knot.
    • Starting from the back of the knot, a suture passage is made in the direction of the incision
    • A passage is made from the other side of the incision parallel to the first pass and in the same direction
    • When the suture is pulled, the tissue becomes inverted and the knot is buried under the skin
    • A suture passage is made in the direction of the incision
    • A passage is made from the other side of the incision parallel to the first pass and in the same direction
    • The last two steps are repeated throughout the incision
    • After the incision line is crossed, End of suture line is fixed by repeating first three steps

• What is a suture ligature (a.k.a. “stick tie”)?
  • Suture is anchored by passing it through the vessel on a needle before wrapping it around and occluding the vessel:
    • Prevents slippage of knot-use on larger vessels

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