Why should we suture a wound
Evidence base
The purpose of suturing is to (Al-Mubarak and Al-Haddab 2013):
- Close open wounds to minimise infection.
- Reduce functional loss.
- Improve the cosmetic results of wound healing.
Other methods of closure include staples, steristrips and surgical tissue adhesive. However, sutures are more versatile and are able to close wounds that are unsuitable for other techniques.
The primary aim of suturing is to join apposing margins of tissue. Eliminating dead space between the damaged tissues allows healing to progress and minimises the risk of infection by reducing the risk of haematoma formation (Hollander and Singer 1999). A haematoma is a localised collection of blood formed outside of a blood vessel.
Haematomas place pressure on healing wounds, thereby increasing the risk of tissue breakdown, and also act as a nutrient-rich medium for bacteria to multiply. The risk of delayed healing is minimised by ensuring that wound margins are everted during suture placement. The slight lifting up of wound margins when they meet ensures that neogenesis can start, providing a scaffold for scar formation.
Improved cosmetic results are another benefit of eversion. As the scar matures, it flattens out, thereby pulling on the healing wound. Eversion allows for remodelling to take place without applying unnecessary tension, thereby improving the appearance of the scar (Wang et al 2015). However, Kappel et al (2015) suggested that there is no significant improvement in scar appearance using eversion, as compared to planar apposition.
Suture techniques
The use of different suture techniques depends on various factors, including the type of wound, its location, skin thickness, wound tension and cosmetic considerations.
Simple interrupted sutures: are the most commonly used sutures (Figure 9a). They are appropriate for most skin closures where the depth of the wound is within the upper dermal layers. Simple interrupted sutures are ideal when contamination of a wound is suspected, since one or two sutures may be removed without affecting the whole closure.
Mattress sutures: are used where the wound is located over an extensor aspect or where the tension of the wound requires additional support during the healing process (Figure 9b and Figure 9c) (Leaper 2006).
Deep dermal sutures: are designed to close wounds when layers other than the upper dermal tissues are involved (Figure 9d). They allow for apposition of the granulation layer by eliminating dead space, thereby facilitating healing. Wounds that have deep dermal sutures allow for easier closure of the superficial layers by simple interrupted sutures.
Learning points
- The purpose of suturing is to close open wounds to minimise infection, reduce functional loss and improve cosmetic results of wound healing.
- The suture technique used will depend on the type of wound, its location, skin thickness, wound tension and cosmetic considerations.
- Simple interrupted sutures are appropriate for most skin closures where the depth of the wound is within the upper dermal layers.
- Mattress sutures are used where the wound is located over an extensor aspect or where the tension of the wound requires additional support during the healing process.
- Deep dermal sutures are designed to close wounds when layers other than the upper dermal tissues are involved.
Disclaimer: Please note that information provided by RCNi Learning is not sufficient to make the reader competent to perform the task. All clinical skills should be formally assessed at the bedside by a nurse educator or mentor. It is the nurse's responsibility to ensure their practice remains up to date and reflects the latest evidence.
Useful resources
- Closing the Gap: Wound Closure for the Emergency Practitioner. https://lacerationrepair.com/ (Last accessed: June 6 2017.)
- NHS Education for Scotland (2011) Suturing. www.csmen.scot.nhs.uk/resources/online-resources/suturing/ (Last accessed: August 2 2017.)
- Suturing Basics: Basics of Wound Closure and Healing. www.bumc.bu.edu/surgery/training/technical-training/suturing-basics/ (Last accessed: June 6 2017.)
References
Armitage J, Lockwood S (2011) Skin incisions and wound closure. Surgery. 29, 10, 496-501.
Bonham J (2016) Assessment and management of patients with minor traumatic wounds. Nursing Standard. 31, 8, 60-69.
Miller CJ, Antunes MB, Sobanko JF (2015) Surgical technique for optimal outcomes: Part 1. Cutting tissue: incising, excising and undermining. Journal of the American Academy of Dermatology. 72, 3, 337-387. MEDLINE
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