From the Guidelines
The recommended spacing for internal sutures in surgical procedures should be approximately 5 mm apart, with a suture length-to-wound length ratio of at least 4:1, using a small bite technique to minimize the risk of incisional hernia and wound complications, as suggested by the World Society of Emergency Surgery guidelines 1.
Key Considerations
- The spacing of internal sutures may vary based on the specific tissue type and surgical location, but a general guideline of 5 mm apart is recommended 1.
- A suture length-to-wound length ratio of at least 4:1 is crucial to avoid the development of incisional hernia and wound complications 1.
- The small bite technique, which consists of a tissue stitch of approximately 5 mm from the median wound edges and a distance of approximately 5 mm from the other stitch, is suggested to ensure adequate distribution of tension on the edge of the incision 1.
Suture Technique
- The use of a continuous running suture with a monofilament material is recommended, as it may decrease the incidence of incisional hernia 1.
- The suture bites should be placed at equal distances from the wound edge on both sides, generally 3-5 mm from the edge, creating evenly distributed tension 1.
Patient Factors
- Surgeons may need to modify the general guideline based on patient factors such as age, nutritional status, presence of comorbidities like diabetes, and whether the tissue is under significant tension 1.
- The use of antimicrobial-coated sutures may be recommended in cases of clean-, clean-contaminated, and contaminated fields when available in the emergency setting 1.
From the Research
Internal Suture Placement
The recommended spacing for internal sutures in surgical procedures is not explicitly stated in the provided studies. However, the following factors can influence the placement of internal sutures:
- The type of suture material used, such as monofilament or multifilament sutures 2
- The size of the suture, with smaller sizes causing less tissue trauma 2
- The location and type of wound or incision 3
- The desired outcome, such as minimizing tissue trauma or promoting wound healing 2, 3
Suture Material Considerations
The choice of suture material can affect the placement and spacing of internal sutures. For example:
- Monocryl® (poliglecaprone 25) and Vicryl Rapide™ (polyglactin 910) are two commonly used suture materials for skin closure 4
- Poliglecaprone 25, polyglactin 910, and polyamide are compared as subcuticular skin stitches in post-cesarean women 5
- Poliglecaprone-25 and polyglactin-910 are compared in cutaneous surgery, with poliglecaprone-25 resulting in significantly less extruded sutures 6
Wound Closure Techniques
The technique used for wound closure can also impact the placement and spacing of internal sutures. For example:
- Barbed sutures can eliminate the need for knots and distribute wound tension more evenly 2
- Modern skin adhesives can function as both wound closure devices and occlusive dressings, eliminating the need for skin sutures 2
- Various suturing techniques, such as subcuticular skin stitches, can be used to promote wound healing and minimize scarring 3, 5