Plastic Surgery Pearls for basic suturing: instruments & technique

Video Type: CVideo
  • 2-5 min videos of a particular surgery or technique. These again show major events in the surgery
  • Clearly annotated and narration is a must in these videos
  • These have clear but concise abstracts are not able to be indexed in PubMed
  • Distributed in newsletters, featured on our website and social media
  • Peer reviewed

Author: Michael Golinko
Published:
Specialties: Plastic Surgery
Schools: Arkansas Children's Hospital
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Basic Info

Contributors: Kumar Patel, PA-C

Basic plastic surgery suturing techniques geared towards medical students and residents, including starting position, basic simple suture, deep dermal suture, vertical mattress, horizontal mattress and running subcuticular.

DOI: http://dx.doi.org/10.17797/udwdtpze6v

Advanced

Procedure

Suturing is the joining of tissue with �needle and thread� so that the tissue binds together and heals. Basic suturing techniques, starting position, basic simple suture, deep dermal suture, vertical mattress, horizontal mattress & running subcuticular. Key technical points emphasized in the video are linked to the principal of "First do no harm" - mindfulness of this principle as it pertains to needle position on the driver and how the needle enters the tissue will produce an optimal wound closure with minimal collateral tissue trauma.

Indications

Simple Suture: can be used in any situation where precise cosmesis is needed such as the face or an area of higher tension or potential infection where removing the suture after closure has little downside.
Deep Dermal Sutures: Indicated in most full thickness wounds and offloads the epidermis; one of the keys to a 'plastics closure'
Horizontal & Vertical Mattress: utilized mainly on the trunk, scalp & extremities for areas of higher tension and where optimal tissue eversion is desired. These are not typically used for facial lacerations nor wounds.
Running Subcuticular: One of the most common skin closures in plastic surgery- though not typically in the face; can simultaneously close the dermal and epidermal layers without the drawback of potential track marks.

closing a laceration closing post excision of tissue, closing dead space, closing a bleeding vessel.

Contraindications

dirty, contaminated or acutely infected wound

Instrumentation

Setup

Sterile field, gather instruments, gather type of suture for the specific repair

Preoperative Workup

skin type and local tissue conditions must be carefully evaluated to achieve a durable and tension-free closure as possible.

Anatomy and Landmarks

the epidermal/ dermal junction is a key landmark for deep dermal sutures and running subcuticular sutures.

Advantages/Disadvantages

Choice of suture and technique may depend on the 1) the local wound characteristics
2) surgeon preference and comfort level 3) patient preference and compliance as to removable sutures or not

Complications/Risks

inflammation of tissue, bleeding, inadequate wound healing, wound infection, spitting of sutures, wound dehiscence, abscess, seroma, epidermal inclusion cyst o

Disclosure of Conflicts

inflammation of tissue, bleeding, inadequate wound healing, wound infection, spitting of sutures, wound dehiscence, abscess, seroma, epidermal inclusion cyst o

Acknowledgements

Tammy Roberson

References

a. http://www.practicalplasticsurgery.org/docs/Practical_01.pdf

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