TRAINING AND EDUCATION

SIMULATION AS PART OF TRAINING CONTINUUM – FROM BASIC SKILLS TO COMPLEX PROCEDURAL TASKS

How to Suture a Wound

If you thought that suturing is a uniform process and is applied on all kinds of wounds, you are wrong. There are different techniques of suturing and the extent of difficulty varies from one another. If you want to minimize scarring impact on the skin, more complicated and complex suturing techniques are implemented.

In this article, there is demonstration of performing intermittent or interrupted sutures, which is the simplest and most straightforward suturing technique. The suture is called interrupted as the stitches are not connected to one another. One stitch is made, it is tied off and then another stitch is made.

Interrupted stitches are secure and simple to place on the skin. When compared to continuous suture, changes to these stitches can be made more easily. Just one stitch needs to be cut, the wound can be adjusted and then a new stitch can be done again.

Mentioned below is guided step for
carrying out interrupted sutures :

  • Wash your hands thoroughly with soap and water so that there are minimal chances of infecting the wound. The wound has to be prepared for suturing. Use water for cleaning the wound. If there is blood, clean the same by using clean cotton and antiseptic lotion. Put on latex gloves so that the hand is not in direct touch with the wound.

  • You must use the needle driver for grabbing the needle properly. The needle clamp should lock in the right place. All the thread should be pulled out of the suture kit.

  • Take the tissue forceps and use it for exposing the side of the wound where you will begin stitching. This will help you in seeing what you are working with and the actual depth of the wound that needs suturing. It is recommended to line up the wound edge as much as possible.

  • At about 90-degree angle, push the needle through the skin. The thread should come about a centimeter to the other side of the wound. See that the thread or the needle does not go below the fat layer in the tissues. It should slide right above it.
  • When you have reached deep enough, twist your hand in clockwise order so that the tip of the needle comes out on the other side of the wound. The needle should come out straight from the first needle hole.

  • When the needle comes out from the other side of the wound, the needle driver should be unlocked and reattached near the needle tip. It has to be pulled until there is about 1-2 inches of thread on the right side of the wound. After this, the needle needs to be released.

  • Use the left hand and hold the thread on the left side itself of the needle. Wrap the thread twice around the needle holder’s tip.

  • Open the needle holder slightly. The 1-2 inches of thread which is there on the right side of the wound needs to be grabbed.
  • Pull the thread’s long part with your left hand. You will see that the thread which is wrapped around the needle holder will slide off. Basically, this is nothing but creating an overhand knot with double loops. This is known as ‘first throw’.

  • The thread has to be tightened in such a manner that the tissues touch one another. Moreover, the knot on the skin should be lying in a flat manner.

  • The process that starts now is referred to as ‘second throw’. Use your left hand and take the long end of the thread and hold it tight. Wrap the thread once in clockwise manner around the needle driver. Open the needle driver slightly and grab the thread’s short end. Use your left hand and pull the long part of the thread. The surgeon’s knot is done with another overhand knot.

  • The above-mentioned step has to be repeated one more time and this is referred to as ‘third throw’. This actually helps in creating a highly secured knot. Instead of wrapping the thread around the needle driver in a clockwise manner, wrap the same in anti-clockwise manner. The knot will not be slipping by any means.

  • Take the scissor and cut off any excess thread that is there.

  • Now it is time for the second suture. Just go quarter of an inch below the wound and repeat the whole process mentioned above.

  • Be careful about one thing. All the knots should be done on one side of the wound. If you tie the knot on the right side of one stitch, let all the knots be on the right side only and vice versa.

  • Be careful about one thing. All the knots should be done on one side of the wound. If you tie the knot on the right side of one stitch, let all the knots be on the right side only and vice versa.

  • Once the stitching work is complete, sutured wound should be wrapped using a sterilized bandage.