3. Suturing
• The skin edges should always be everted when
suturing is complete.
• This results in:
• Better dermal apposition
• Improved healing
• A finer final scar.
4. Cutaneous suture
• The aim of this suture is to accurately appose
and evert the skin edges.
5. Cutaneous suture
• The following may be helpful in achieving this.
• When viewed in a cross-section, the suture
passage should be triangular-shaped
– with its base located deeply as this will evert the
wound edges.
– A triangular-shaped suture passage with the base
located superficially tends to invert the wound
edges.
10. Dermal suture
• Most wounds are closed by first opposing the
skin edges with a dermal suture.
• This reduces the tension on the subsequent
cutaneous suture and helps to limit
• stretching of the wound.
• Use either monocryl (face) or pds
11. Dermal suture
• The dermal suture should enter the deep reticular
dermis on the incised edge of the wound.
• It should then pass superficially into the papillary
dermis.
• The knot should be tied deeply to prevent
subsequent exposure of the suture.
• This method of suture placement produces good
apposition and eversion of the skin edges.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21. Cheat stitch
• This combination dermal and interrupted
suture is helpful with wounds under tension
• Especially when you are happy to leave the
suture in for 2 weeks and stitch marks not a
great concern
– Backs, legs, arms
22.
23.
24.
25.
26.
27.
28.
29. Fudging!
• If one of the wound edges lies lower than the
other, the suture should be passed through
the cut edge of the skin low on that side (‘low-
on-the-low’).
30. Fudging!
• If one of the wound edges lies higher than the
other, the suture should be passed through
the dermis high on that side (‘high-on-the-
high’)
• Passing the suture in this way acts to flatten
out any vertical step between the wound
edges and ensures that the sides are on a level
plane.
31. • Fine adjustments can be made by changing
the side on which the knot lies
– the knot will tend to raise the side on which it lies
32.
33.
34.
35. Subcuticular/Intradermal
• The suture passes through the dermis, not
under the skin.
• Should always be there to approximate the
epithelium with no tension
• The hard work is done by the deep dermals
36. Another cheat stitch
• Useful for long wounds where you want to
save time but still get everted skin edges
• Combination of “over and over” and
horizontal mattress
39. Vicryl
• Vicryl is a braided synthetic
suture
• It loses its strength by 21
days and is absorbed by 90
days.
• Its braided nature may
make it more prone to
bacterial colonization than
monofilament alternatives.
• It may provoke a significant
inflammatory reaction
• Don’t use as a dermal
suture in the face.
40. PDS
• PDS is a monofilament
synthetic suture composed
of polydioxone.
• It is absorbed more slowly
than either vicryl, monocryl
or dexon.
• It loses its strength by 3
months and is absorbed by
6 months.
• It is primarily used as a
dermal suture in areas
prone to developing
stretched scars.
41. Monocryl
• Monocryl is a
monofilament synthetic
suture composed of
poliglecaprone 25.
• It has similar absorption
characteristics to vicryl.
• Its monofilament
composition may make
it less prone to bacterial
colonization.
42. What suture when?
• Sutures that retain their strength for a
significant amount of time, such as a PDS,
should be used in areas prone to scar
stretching, such as the back, legs torso.
• Sutures that elicit a minimal tissue reaction,
such as monocryl, should be used in the face.
43. Face
• Kids • Adults
– 6.0 fastgut with – Nylon or prolene
dermabond glue to • Skin
waterproof • 5.0 or 6.0
– Steristrips on top of – Monocryl
wound • Dermal
• 5.0
– Remove sutures day 5 or
6
– No later as may leave
stitch marks
44.
45. Scalp
• Kids • Adults
– Vicrylrapide/vicryl – Staples or any suture
– monocryl different colour to
patients hair
46. Rest of body
• Kids • Adults
– Same as adults – Depends on extent of
wound and depth
• Usually dermal
pds/monocryl
• Interrupted
nylon/prolene