The video presented by Zenn (2013) describes the most common types of sutures in a rather engaging and informative way. Being a specialist in an emergency room department, I have frequently observed professionals performing sutures. However, this video lesson was useful in explaining the detailed process of suturing simply.
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A nurse must know the relevant autonomy and understand the fundamental structures before choosing suturing as the most appropriate method of wound closure (Bonham, 2016). Also, it is necessary to prepare all the equipment required for the procedure. In the majority of departments, there are pre-packed suture sets that consist of the following items: a container for cleaning agents, a needle holder, scissors, toothed and non-toothed forceps, sterile gauze swabs, sterile drapes, and suture material (Bonham, 2016). Other essential tools are a syringe and a scalpel. Before suturing, a nurse should assess and clean the wound. If there is bleeding, it should be soaked up with sterile gauze. To avoid future contact with the surrounded skin, sterile drapes are used (Bonham, 2016). Finally, it is crucial to make sure that the patient has received anesthesia, and that it has worked.
A simple interrupted suture is used when a team consisting of many specialists is working (Zenn, 2013). During this procedure, it is important to make a minimum of three thrown before finishing the suture. Simple interrupted sutures are used in thoracic and cardiovascular surgery to prepare large effective opening areas and eliminate the occurrence of the prosthesis (Tabata et al., 2014). A simply buried suture is employed before when putting deeper sutures in before putting the skin sutures in (Zenn, 2013). It is crucial to bury a suture, so it starts deep and goes superficial, ending up in the dermis and leaving no hole in the skin. On the other side, the procedure is the opposite way. It goes superficial at first, and then deep (Zenn, 2013). Simply buried sutures are used to avoid scars (Yang et al., 2018).
A vertical mattress suture is used when a wound is hard to close or when there is much swelling already present or expected (Zenn, 2013). This suture is frequently employed in cosmetic surgery. However, it has proved to be less effective than a set-back suture, the latter bringing more positive cosmetic outcomes (Wang et al., 2015). A horizontal mattress suture may be explained as a succession of two simple sutures (Zenn, 2013). Upon exiting the needle on the first pass, it is reinserted in the way that makes the re-entry mark parallel to the exit mark. The ending point is parallel to the original entry mark (Bonham, 2016). This suture is rather time-efficient (Zenn, 2016).
Another time-saving suture is a figure-of-eight one. By performing it, it is possible to make twice as few knots, thus finishing the work faster (Zenn, 2013). According to Traullé et al. (2015), a figure-of-eight suture is a speedy method of closure that can be employed as an effective substitute for common compression techniques to prevent bleeding in the process of high-intensity anticoagulation. A half-buried horizontal mattress is used in cosmetic surgery to avoid post-suture holes. When performing this type of suture, it is necessary to start a horizontal mattress on one side and remain within the dermis on the opposite side in a subcuticular manner, and then come back on the other side as in a simple horizontal mattress. This method results in having suture marks only on one side of the wound (Zenn, 2013).
The most common type of suture used to close incisions is simple running. This suture begins with an instrument tie (Zenn, 2016). It is necessary to take ninety-degree bites and be consistent in what concerns the distance between stitches. It is also required to guarantee enough tension along the incision. By doing so, it is possible to achieve the most favorable cosmetic outcomes. In the end, another instrument tie is performed (Zenn, 2016). A simple running locking suture is similar to the previous type, but it requires locking each suture before making another one. This approach is useful when a specialist is working alone, and no assistance in holding the suture is available. Thus, the suture holds itself (Zenn, 2016). The most complicated suture is subcuticular (Zenn, 2016). This method leaves no external signs of suture at all. The instrument tie is hidden deep in the wound, and all the other operations are also hidden. The effect of this suture is the most cosmetic closure of all.
Judging from the video and my professional experience, I realize the importance of learning how to suture. The aim of suturing is to minimize the possibility of infection by connecting the apposing tissue margins (Al-Mubarak & Al-Haddab, 2013). With the help of efficient suturing, it is possible to eliminate functional loss, enhance the process of healing, and provide the best cosmetic outcomes. Therefore, this video is highly useful for specialists who endeavor to develop their professional skills and enrich their knowledge.
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Al-Mubarak, L., & Al-Haddab, M. (2013). Cutaneous wound closure materials: An overview and update. Journal of Cutaneous and Aesthetic Surgery, 6(4), 178-188.
Bonham, J. (2016). How to suture a wound. Nursing Standard, 31(8), 42-46.
Tabata, M., Shibayama, K., Watanabe, H., Sato, Y., Fukui, T., & Takanashi, S. (2014). Simple interrupted suturing increases valve performance after aortic valve replacement with a small supra-annular bioprosthesis. The Journal of Thoracic and Cardiovascular Surgery, 147(1), 321-325.
Traullé, S., Kubala, M., Doucy, A., Quenum, S., & Hermida, J.-S. (2015). Feasibility and safety of temporary subcutaneous venous figure-of-eight suture to achieve haemostasis after ablation of atrial fibrillation. Europace, 18(6), 815-819.
Wang, A. S., Kleinerman, R., Armstrong, A. W., Fitzmaurice, S., Pascucci, A., Awasthi, S., … Eisen, D. B. (2015). Set-back versus buried vertical mattress suturing: Results of a randomized blinded trial. Journal of the American Academy of Dermatology, 72(4), 674-680.
Yang, J., Kim, K. H., Song, Y. J., Kim, S.-C., Sung, N., Kim, H., Lee, D. H. (2018). Cosmetic outcomes of cesarean section scar; subcuticular suture versus intradermal buried suture. Obstetrics and Gynecology Science, 61(1), 79-87.
Zenn, M. (2013). Suture skills course – Learn best suture techniques [Video file]. Web.