1.Simple interrupted sutures
This can be either:
- Simple Interrupted
- Used on majority of wounds
- Each stitch is independent
Suture Techniques
2. Vertical vs Horizontal Mattress sutures
Vertical Mattress – Useful for everting skin edges “Far-far-near-near”
Horizontal Mattress – Useful for single-layer closure of lacerations under tension
3. V-shaped wound closure
How do you Hand tie?
Aftercare
Dressings/ Surveillance for complications
- Consider splinting digits, joint surfaces
- Check tetanus status
- Pre-printed wound care instructions
- Pt must understand signs of infection
Once the scab has fallen off, massage and moisturize to reduce the risk of keloids and hypertrophic scar formation, this includes avoiding sun exposure, sunblock.
The district nurse or GP can follow simple, uncomplicated wounds for further wound care and suture removal.
Higher risk wounds must be reviewed earlier (24-48hrs), either at the ED clinic or respective speciality. Examples of high-risk injuries: hand wounds, Bites, heavily contaminated or wounds requiring antibiotics.
REMOVAL OF SUTURES
| Anatomic Area | Days until Removal | External suture size | Buried Absorbable suture size |
| Face | 4-5 | 5-0 or 6-0 | 5-0 |
| Scalp | 10-14 | 4-0, staples | 3-0 |
| Upper body | 7-10 | 4-0 | 4-0 |
| Hand | 7-10 | 4-0 or 5-0 | 4-0 |
| Lower body | 10-14 | 4-0 | 3-0 |
| Over joint (splint recommended) | 14-21 | 4-0 | 3-0 |
Adapted from Face and scalp lacerations: timing for suture removal.10
- Physiotherapy and rehabilitation
- Injuries with associated fracture
- Injuries affecting joints
- Injuries to special areas.