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Here is a comprehensive guide on wound/plain closure (suturing and wound closure methods):
Wound Closure — Methods & Techniques
1. Decision: What Method to Use
The choice of closure depends on wound location, size, shape, and contamination level:
| Method | Best Used When |
|---|---|
| Sutures | Most wounds; provides strongest closure |
| Staples | Linear lacerations through dermis with straight, aligned edges (not on face or feet) |
| Adhesive strips (Steri-strips) | Small, low-tension wounds |
| Tissue adhesive (e.g., Dermabond) | Small incisions, low tension; water-impermeable |
2. Suturing Techniques
| Technique | Purpose |
|---|---|
| (A) Simple interrupted | Basic closure of most uncomplicated wounds |
| (B) Vertical mattress | Added strength in thick skin or areas of movement; everts wound edges |
| (C) Horizontal mattress | Everts wound edges; reduces tension |
| (D) Deep dermal (subcuticular) | Cosmetic closure; buried absorbable suture pulls deeper layers together |
| Running intradermal | Cosmetic closures |
3. Layered Closure
- Fascia: Closed with absorbable suture (running or interrupted)
- Subcutaneous fat: Do not suture — absorbable suture tears through fat
- Muscle fascia: Repair with absorbable suture if lacerated
- Skin/dermis: Closed last with nonabsorbable or absorbable suture
4. Suture Material & Size by Body Region
| Body Region | Nonabsorbable | Absorbable | Removal (Days) |
|---|---|---|---|
| Scalp | 5-0 or 4-0 | 4-0 | 5–7 |
| Face | 6-0 | 5-0 | 3–5 |
| Eyelid | 7-0 or 6-0 | — | 3–5 |
| Trunk | 5-0 or 4-0 | 3-0 | 5–7 |
| Extremities | 5-0 or 4-0 | 4-0 | 7–10 |
| Joint surface | 4-0 | — | 10–14 |
| Hand | 5-0 | 5-0 | 7 |
| Foot sole | 4-0 or 3-0 | 4-0 | 7–10 |
5. Common Suture Materials
Absorbable:
- Vicryl (braided) — subcutaneous closure, vessel ligature; absorbed in 8–10 weeks
- Monocryl (monofilament) — subcuticular; absorbed in 13–17 weeks
- Plain gut — subcutaneous; loses strength by 7–10 days
- Chromic gut — subcutaneous; holds slightly longer (~21–23 days)
Nonabsorbable (skin):
- Nylon (Ethilon, Dermalon) — monofilament; loses ~20% tensile strength/year; standard skin suture
- Prolene — monofilament polypropylene; minimal tissue reaction
6. Types of Wound Closure by Timing
| Type | Description |
|---|---|
| Primary closure | Wound closed immediately (clean/clean-contaminated wounds) |
| Delayed primary closure | Wound left open 2–5 days, then closed (contaminated wounds) |
| Secondary (open) intention | Wound left open to heal naturally; serial packing (heavily contaminated/dirty wounds) |
| Negative pressure wound therapy | Vacuum device applied to open wounds to facilitate closure |
7. Special Situations
- High-tension areas (knee, joint surfaces): Use horizontal mattress or vertical mattress sutures; consider splinting afterward
- Contaminated wounds: Delayed closure or leave open
- Lower extremity: Often requires multi-layer closure due to increased wound tension
- Face/lips/genitalia/periorbital: May need specialist consultation
Sources:
- The Harriet Lane Handbook (23rd ed.), B. Basic Laceration Repair
- Sabiston Textbook of Surgery, Wound Closure
- Tintinalli's Emergency Medicine, Wound Closure
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