INTERRUPTED SUTURE

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INTERRUPTED SUTURE

An interrupted suture is called that because not each stitch is interconnected. Do one, tie it off, and then do another. Most preferred for skin closure method and epidermal approximation. It may be used alone in small wounds where there is little or no tension, such as formed by either a small bunch biopsy or a traumatic laceration. It is also commonly used as a secondary layer to assist the epidermis approach when the dermis is closed using a dermal or other deep suture technique.

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1. Procedure

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1. The stitches should be placed horizontally from right to left. Left-handed surgeons are advised to work in the opposite direction.
2. Holding the needle with needle drivers, introduce the needle through the tissue on the far side of the wound 2–5 mm away from the tissue edge. If sutures are positioned too close to the edge, there is a risk that they will pull through.  If they are too far from the edge, too big a thickness of tissue will be pulled up and may invert. Due to this, cause an unsightly suture line, which may take long time to heal or may scar.
3. Move the needle to the opposite side 2-5 mm away from the tissue edge.
4. Pull the suture material through leaving approximately 3 cm sticking out of the far side. The suture material will be used for the knot forming. Do not pull the suture right through the wound as you will then have to repeat it.
5. Knot the two ends of sutures together. The knot must be left balanced from the wound and not resting in the incision area. Because it interferes with the healing process and then it is difficult to remove it from the tissue.
6. Cut the suture material on either side, leaving the ends approximately 2–3 mm long. The suture ends must be long enough to grasp with forceps during removal of the suture. If the suture knot ends are too long, they may invite interference by the patient. On the other hand, too short suture ends may unravel later.
7. The suture obtained should be tight enough to allow the tissues to come together, but loose enough to prevent inversion of the edges. Excessive tension and inversion of the suture line can cause delayed healing and pain, which could lead to patient interference.
8. Place the next suture approximately 5 mm away from the wound. The distance apart depends on area and texture of the wounds.

1. Advantages and Disadvantages

Advantages of interrupted suture:

1. It is used in areas where the tissues are under stress
2. Sutures are placed 4-8 mm apart can be used to close large wounds where the tension is shared between each one separately
3. In case of loosening of one suture, others won’t be affected
4. If any secondary infection or hematoma occurs, some sutures may be removed and others left in place.

It is easy to clean as there are no interferences between each suture and they are not connected

Disadvantages of the interrupted suture:  

1. The presence of more knots and more suture material within the wound may result in increased inflammation response and increased risk of
2. Interrupted sutures take long time to do.
3. It should not be preferred in aesthetic surgery due to the development of suture tracks. The risk can be minimized by removing sutures early to prevent the development of suture tracks.

   ASLI BİROL

Quality Assurance Representative