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Suture patterns

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Introduction

  • Probably as many different suture patterns as there are suture materials. Patterns consist of two basic types.
  • Interrupted - each stitch is cut and tied as a separate entity   Suture patterns: simple interrupted 01    Suture patterns: simple interrupted 02    Suture patterns: simple interrupted 03    Suture patterns: simple interrupted 04    Suture patterns: simple interrupted 05    Suture patterns: simple interrupted 06    Suture patterns: simple interrupted 07   Suture patterns: simple interrupted 08   Suture patterns: simple interrupted 09 :
    • Advantages:
      • Allow precise adjustment of tension along the length of wound.
      • Failure of a single knot may not cause wound to break down.
      • Suitable for all tissue types.
    • Disadvantages:
      • Time consuming to place.
      • More knots, therefore more suture material left in wound.
  • Continuous -  knots are placed only at the end of a running line of continuous stitches:
    • Advantages:
      • Less time consuming than interrupted patterns.
      • Less suture material left in the wound.
      • Relatively fluid and airtight.
    • Disadvantages:
      • Failure of securing or finishing knot likely to lead to unravelling of entire suture line.
  • Suture patterns can also be classified as everting, inverting and apposing:
    • Everting tends to turn the tissue edges outward.
    • Inverting sutures tend to turn the tissue inward.
    • Apposing sutures bring the tissue edges into direct contact without eversion or inversion.
  • Another differentiation in suture patterns is whether they are a simple or mattress (tension) suture:
    • Mattress patterns:
      • Close an incision under tension better than simple patterns.
      • May slow down healing by compressing tissue on each side of the incision.
      • Designed to withstand more tension by spreading the tension over a wider area.
      • May be appositional, inverting, or everting depending on whether suture material is placed full or partial thickness within skin edge.

Suture knots

  • There are some guiding principles of knot formation that should be followed:
    • Knots should be as small as possible to minimize foreign body reactions.
    • After the first loop is tied in a knot traction should be maintained to avoid loosening.
    • Extra knots do not add strength to an accurately tied knot.
  • Useful knots to learn:
    • Aberdeen knot: the Aberdeen knot has been shown to be stronger and more secure than a surgeon's knot for ending a suture line. The Aberdeen knot is also of a smaller volume than a standard surgeon's knot . An Aberdeen knot tied with three throws and two turns has been shown to provide the maximum level of security.
    • Sliding knot: useful for placing a ligature deep in a body cavity, it should alsways be covered with a square knot for security to prevent the knot loosening.

Skin closure

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Muscle and fascia closure

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Hollow organ closure

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Tension sutures

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Tendon repair (Anastomosis)

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Special Suture and Ligature Patterns

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Duffy D J, Main R P, Moore G E et al (2015) Ex vivo biomechanical comparison of barbed suture and standard polypropylene suture for acute tendon laceration in a canine model. Vet Comp Orthop Traumatol 28 (4), 263-269 PubMed.
  • Wilson L, Banks T, Luckman P et al (2014) Biomechanical evaluation of double Krackow sutures versus the three-loop pulley suture in a canine gastrocnemius tendon avulsion model. Aust Vet J 92 (11), 427-432 PubMed.
  • Moores A P, Owen M R, Tarlton J F (2004) The three-loop pulley suture versus two locking-loop sutures for the repair of canine achilles tendons. Vet Surg 33 (2), 131-137 PubMed
  • Weisman D L, Smeak D D, Birchard S J et al (1999) Comparison of a continuous suture pattern with a simple interrupted pattern for enteric closure in dogs and cats: 83 cases (1991-1997). J Am Vet Med Assoc 214 (10), 1507–1510 PubMed.
  • Bellah J R (1994) Surgical stapling of the spleen, pancreas, liver, and urogenital tract. Vet Clin N Am: Small An Prac 24 (2), 375-394 PubMed.
  • Kirpensteijn J, Fingland R B & Boyer J E Jr. (1993) Comparison of stainless steel fascial staples and polypropylene suture material for closure of the linea alba in dogs. Vet Surg 22 (6), 464-472 PubMed.
  • Pavletic M M (1990) Surgical stapling devices in small animal surgery. Compend Contin Educ Pract Vet 12 (12), 1724-1741 VetMedResource.
  • Court M H & Bellenger C R (1989) Comparison of adhesive polyurethane membrane and polypropylene sutures for closure of skin incisions in cats. Vet Surg 18 (3), 211-215 PubMed.
  • Smeak D D & Wendelburg K L (1989) Choosing suture materials for use in contaminated or infected wounds. Compend Contin Educ Pract Vet 11 (4), 467-475 VetMedResource.
  • Berg R J, Egger E L (1986) In vitro comparison of the three loop pulley and locking loop suture patterns for repair of canine weight bearing tendons and collateral ligaments. Vet Surg 15 (1), 107-110 Wiley Online Library.
  • Stashak T S (1977) Reconstructive Surgery in the Horse. J Am Vet Med Assoc 170 (2), 143-149 PubMed.

Other sources of information

  • Bojrab M J (1988) Suture Use Manual. Copyright, Pitman-Moore Inc. pp 1-23.
  • Suture materials. (1987) In: Fundamental techniques in Veterinary Surgery. Eds C D Knecht et al. W B Saunders Co, Philadelphia. pp 39-71.
  • Boothe H W (1985) Suture materials and tissue adhesives. In: Textbook of Small Animal Surgery. Ed D H Slatter. W B Saunders Co. Philadelphia. pp 334-344.
  • Pullen C M (1975) Reconstruction of the Skin. In: Current techniques in Small Animal Surgery. Ed M J Bojrab. Lea and Febiger, Philadelphia.

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