Sutures

Suture Patterns

1. Sutures

2. Interrupted suture patterns Simple Cruciate Vertical mattress Horizontal mattress Far and near

3. Subdivisions of interrupted simple- single passage through each side of incision, then tied Mattress- two opposite passages through each side of incision then tied

4. Advantages/disadvantages interrupted Advantages ease, adjustable tension, if one knot fails less of a problem, strength and tissue mobility Disadvantages - More time ( time is trauma in surgery) and material

5. Simple interrupted technique: Single passage through each side, perpendicular across incision goal: Appositional Issues: Too tight will cause necrosis, invert or evert of tissue

6. Simple interrupted

7. Cruciate pattern Technique: first pass perpendicular to incision, second pass parallel to form an X across incision goal: apposition, moderate tension, allows for some swelling applications: skin, body wall closure

8. Cruciate pattern

9. Vertical mattress Technique: two passages on each side of incision, in same plane Not the same as: far-far-near-near Goal: apposition to slight elevation Tension- relieving suture, buttons, rubber tubing Applications: skin, fascia, if really tight skin, minimizes tissue trauma to close wound

10. Vertical mattress

11. Horizontal mattress Technique- two passages on same side in same horizontal plane to make a square Tension- relieving suture, buttons, rubber tubing Issue- may interfere with blood supply to skin edges Applications- skin, fascia best to use tubing so you can pull tight

12. Horizontal mattress

13. Near and far sutures Types- pulley sutures Tension- relieving Variation of-vertical mattress, far far near near and far near near far Use – not common in small animal, use in large esp. tendons Don’t confuse with- mattress sutures

14. Near and far sutures

15. Continuous suture patterns Simple Ford interlocking Intradermal Cushing/ connell lembert

16. Advantages/disadvantages continuous Advantages: speed, less suture material, ease of removal, better seal Disadvantages: loss of knots or suture breakage, more disastrous

17. Simple continuous suture pattern Technique- single passage on each side perpendicular across incision Goal- appositional Issues- too tight, tissue will necrose , invert, evert or wrinkle Use – good seal, ease of use Tension- minimal to moderate tension

18. Simple continuous

19. Intradermal suture Placement- within dermis, subcuticular Start- begin with buried interrupted knot Technique- pass sutures in dermis parallel to incision, continuous horizontal mattress Type of suture to use- absorbable suture Needle- cutting

20. Intradermal suture

21. Continuous ford interlocking advantages Less likely to fail with breakage or knot loosening Better tissue apposition Greater tissue stability Disadvantages - More material, time, may be too tight an cut into tissue

22. Ford interlocking technique Modified simple continuous Each passage is linked to the previous passage Bring suture up through the loop that has been created

23. Ford interlocking

24. Cushing/ connell suture patterns Type of pattern- inverting continuous suture pattern Use- closing hollow viscera in equine, more common to use simple continuous in small animal Technique- suture passed parallel to incision, cushing - partial thickness, connell full thickness

25. Cushing/ connell

26. lembert Type- inverting suture pattern Use- closure of hollow viscera Layers- second layer Technique – suture passed perpendicular to incision, suture enters and exits on same side of incision Depth of suture placement- partial thickness

27. lembert

28. Inverting suture pattern Do not use in small animals, they don’t have luminal diameter to tolerate it and may cause stricture