What are the commonly taught surgical suturing techniques?

From the Guidelines

The most commonly taught surgical suturing techniques include simple interrupted, continuous (running), mattress (both vertical and horizontal), subcuticular, and purse-string sutures, with the 'small bite' technique being recommended for midline emergency laparotomy closures due to its association with lower incisional hernia and wound complication rates 1.

Key Suturing Techniques

• Simple interrupted sutures: individual stitches tied and cut separately, providing good wound edge eversion and strength
• Continuous sutures: a single strand of suture material placed in a running fashion, faster to place but may cause tissue strangulation if too tight
• Mattress sutures: excellent wound edge eversion, useful in high-tension areas
• Subcuticular sutures: placed just beneath the epidermis for cosmetically sensitive areas, minimizing scarring
• Purse-string sutures: create a circumferential closure, commonly used for stoma closures

Recommendations for Emergency Laparotomy Closures

• Continuous suture technique is suggested for midline abdominal wall incision in emergency settings, as it reduces the time taken for fascial closure 1
• The 'small bite' technique, with a tissue stitch of approximately 5 mm from the median wound edges and a distance of approximately 5 mm from the other stitch, is recommended for midline emergency laparotomy closures due to its positive effects on wound healing 1
• Antibiotic-coated sutures may be considered in emergency settings to reduce the rate of surgical site infections, especially in clean-, clean-contaminated, and contaminated fields 1
• Retention sutures may be considered as an addition to suture closure of emergency laparotomy in patients with high-risk conditions for incisional hernia and wound dehiscence, but their use is not routinely recommended due to higher postoperative pain 1

From the Research

Commonly Taught Surgical Suturing Techniques

• Subcuticular suture is an important technique for achieving optimum wound closure 2
• Buried suture is the oldest subcuticular suture technique, followed by buried vertical mattress suture, intracutaneous butterfly suture, modified/variant buried vertical mattress suture, intradermal buried vertical mattress suture, buried horizontal mattress suture, wedge-section and modified buried vertical mattress suture, set-back suture, and modified buried horizontal mattress suture 2
• Buried vertical mattress suture is currently the most widely used subcuticular suture technique 2
• Skin sutures can be continuous or interrupted, with continuous sutures usually being subcuticular and absorbable or non-absorbable, while interrupted sutures are usually non-absorbable and involve the full thickness of the skin 3
• Continuous sutures can be divided into transdermal or subcuticular sutures according to whether the stitches are placed through or below the epidermal layer 4
• Interrupted sutures involve penetration of the loose connective tissue beneath the skin layers, with stitches placed through the external skin layer 4

Comparison of Suturing Techniques

• Continuous subcuticular sutures may reduce superficial wound dehiscence compared to interrupted sutures 3
• The incidence of dehiscence events was significantly lower in continuous sutures compared to interrupted sutures 4
• Subcuticular continuous sutures had higher visual analogue scale (VAS) scores among patients and doctors than interrupted sutures, indicating better cosmetic appearance 4
• Transdermal continuous sutures also had better cosmetic appearance compared to interrupted sutures 4
• There was no significant difference in infection events rates between continuous and interrupted sutures 4