From the Guidelines
Sutures are necessary for wounds that are deep, gaping, or under high tension, and the use of monofilament sutures with a small bite technique and a suture length-to-wound length ratio of 4:1 or higher is recommended to reduce the risk of incisional hernia and wound complications. When considering the necessity of sutures, it's essential to evaluate the wound's characteristics, such as its depth, length, and location. Wounds that are longer than 1-2 centimeters, penetrate through all skin layers, have jagged edges, or continue to bleed despite pressure typically require sutures 1. Additionally, facial wounds often need sutures for cosmetic reasons, even if smaller. The timing of suturing is also crucial, with most wounds requiring closure within 6-8 hours of injury, although facial wounds can sometimes be sutured up to 24 hours later.
The choice of suture material is also important, with monofilament sutures being associated with a lower risk of incisional hernia compared to multifilament sutures 1. The small bite technique, which involves taking small stitches with a distance of approximately 5 mm from the wound edge and between stitches, has been shown to reduce the risk of wound complications 1. Furthermore, a suture length-to-wound length ratio of 4:1 or higher is recommended to minimize the risk of incisional hernia and wound complications 1. By following these guidelines, healthcare professionals can optimize wound closure and promote proper healing, reducing the risk of morbidity and mortality, and improving the patient's quality of life.
Some key points to consider when deciding on the necessity of sutures include:
- Wound depth and length
- Location of the wound, with facial wounds requiring special consideration
- Presence of jagged edges or ongoing bleeding
- Timing of suturing, with most wounds requiring closure within 6-8 hours
- Choice of suture material, with monofilament sutures being preferred
- Use of the small bite technique and a suture length-to-wound length ratio of 4:1 or higher.
From the Research
Suture Necessity
Sutures are necessary in various situations, including:
- Closing wounds to provide mechanical support and promote healing 2
- Facilitating wound closure and creating an optimal setting for wound healing 2
- Repairing skin lacerations, particularly in areas with high skin tension 3
- Closing large and difficult-to-close wounds, where undermining and pulley sutures can be helpful 4
- Adapting wound edges and tissues, with different tissues and layers having different requirements regarding the suture material 5
Suture Material Considerations
When choosing a suture material, considerations include:
- Strength of suture 2
- Holding power of tissue 2
- Absorbability 2, 6
- Risk of infection 2, 3
- Inflammatory reaction associated with the suture material 2, 6
- Type of incision, suturing technique, and appearance of wound site 2
Suture Techniques and Applications
Sutures can be used in various techniques, including:
- Simple, running, and half-buried mattress (corner) sutures 3
- Buried sutures to provide adequate support to the infrastructure of the wound 4
- Intraoperative skin expansion to close wounds that could not be closed by any other technique except for skin grafting 4
- One-hand and two-hand techniques of surgical knots 5