Stitching sutures. Explore the World of Surgical Sutures: Types, Comparisons, and More

03.05.202309.06.2023 by alexxlab

Discover the ins and outs of surgical sutures. Learn about the different types, their advantages and disadvantages, and how they compare to stitches. Get a comprehensive overview to make informed decisions about your healthcare.

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Unraveling the Mysteries of Surgical Sutures

Surgical sutures play a crucial role in the healing process, as they are used by healthcare professionals to close wounds and facilitate tissue repair. These tiny threads, meticulously crafted, come in a variety of materials and configurations, each designed to address specific needs and preferences. In this comprehensive article, we’ll delve into the world of surgical sutures, exploring their types, characteristics, and how they compare to traditional stitches.

Classifying Surgical Sutures: Absorbable vs. Non-absorbable

The primary distinction among surgical sutures lies in their ability to be absorbed by the body. Absorbable sutures, such as gut, polydioxanone (PDS), poliglecaprone (MONOCRYL), and polyglactin (Vicryl), are designed to gradually break down and be naturally eliminated by the body’s enzymes. In contrast, non-absorbable sutures, including nylon, polypropylene (Prolene), silk, and polyester (Ethibond), remain in place and require removal by a healthcare professional at a later date or may be left in permanently.

Exploring the Material Composition of Sutures

Suture materials can be further categorized based on their physical structure. Monofilament sutures, such as gut and polypropylene, consist of a single continuous thread, allowing for easier passage through tissues. Braided sutures, on the other hand, are composed of multiple smaller threads woven together, offering enhanced security but potentially increasing the risk of infection.

Natural vs. Synthetic Sutures: Weighing the Pros and Cons

Sutures can also be classified according to their source, with natural materials like gut and silk being derived from organic sources, while synthetic sutures, such as polydioxanone and polyester, are man-made. Although this distinction may seem significant, the sterilization process ensures that both natural and synthetic sutures are equally safe for medical use.

Sutures vs. Stitches: Clearing the Confusion

It’s important to note that the terms “suture” and “stitch” are often used interchangeably, but they actually refer to different aspects of the wound closure process. A suture is the actual medical device, while a stitch is the technique employed by healthcare professionals to close the wound using the suture material.

Sizing Up Suture Specifications

Suture material is graded based on the diameter of the suture strand, using a numerical system that indicates the size. The higher the number, the smaller the diameter of the suture, which can impact factors such as tissue tension and scarring. Additionally, the suture material is paired with a needle, which can vary in size and edge characteristics, further influencing the overall effectiveness of the wound closure.

Suture Techniques: A Diverse Approach

Just as there are numerous types of sutures, healthcare professionals have a wide range of suture techniques at their disposal. These techniques, such as continuous, interrupted, and subcuticular, are chosen based on the specific needs of the wound, the desired aesthetic outcome, and the provider’s expertise.

Choosing the Right Suture: Factors to Consider

When it comes to selecting the appropriate suture, healthcare professionals must carefully consider various factors, including the type of tissue being repaired, the desired healing timeline, the location and size of the wound, and the patient’s individual characteristics and preferences. By understanding these considerations, patients can work collaboratively with their healthcare team to ensure the most suitable suture choice for their specific needs.

Sutures and Scarring: Minimizing the Impact

While the primary function of sutures is to facilitate wound healing, the choice of suture material and technique can also impact the cosmetic outcome, particularly in terms of scarring. Healthcare providers carefully weigh these considerations, selecting sutures and techniques that optimize both functional and aesthetic outcomes for their patients.

Suture Removal: When and How?

For non-absorbable sutures, the healthcare provider will determine the appropriate timing for suture removal, based on factors such as the type of wound, the location, and the patient’s healing progress. This process is typically straightforward and can be performed in an outpatient setting, allowing patients to resume their normal activities with minimal disruption.

Navigating the Complexities of Suture Selection

Selecting the right suture for a specific medical procedure or wound closure can be a nuanced and complex process. Healthcare providers must carefully weigh the unique characteristics of each suture type, the specific needs of the patient, and the desired clinical outcomes. By understanding the intricacies of surgical sutures, patients can engage in informed discussions with their healthcare team, ultimately contributing to the success of their treatment and overall well-being.

Surgical Suture: Types, Vs. Stitches, More

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Medically reviewed by Andrew Gonzalez, M. D., J.D., MPH — By Jill Seladi-Schulman, Ph.D. — Updated on April 6, 2018

Overview

Sutures are used by your doctor to close wounds to your skin or other tissues. When your doctor sutures a wound, they’ll use a needle attached to a length of “thread” to stitch the wound shut.

There are a variety of available materials that can be used for suturing. Your doctor will choose a material that’s appropriate for the wound or procedure.

The different types of sutures can be classified in many ways.

First, suture material can be classified as either absorbable or nonabsorbable.

Absorbable sutures don’t require your doctor to remove them. This is because enzymes found in the tissues of your body naturally digest them.

Nonabsorbable sutures will need to be removed by your doctor at a later date or in some cases left in permanently.

Second, the suture material can be classified according to the actual structure of the material. Monofilament sutures consist of a single thread. This allows the suture to more easily pass through tissues. Braided sutures consist of several small threads braided together. This can lead to better security, but at the cost of increased potential for infection.

Third, sutures can be classified as either being made from natural or synthetic material. However, since all suture material is sterilized, this distinction is not particularly useful.

Types of absorbable sutures

Gut. This natural monofilament suture is used for repairing internal soft tissue wounds or lacerations. Gut shouldn’t be used for cardiovascular or neurological procedures. The body has the strongest reaction to this suture and will often scar over. It’s not commonly used outside of gynecological surgery.
Polydioxanone (PDS). This synthetic monofilament suture can be used for many types of soft tissue wound repair (such as abdominal closures) as well as for pediatric cardiac procedures.
Poliglecaprone (MONOCRYL). This synthetic monofilament suture is used for general use in soft tissue repair. This material shouldn’t be used for cardiovascular or neurological procedures. This suture is most commonly used to close skin in an invisible manner.
Polyglactin (Vicryl). This synthetic braided suture is good for repairing hand or facial lacerations. It shouldn’t be used for cardiovascular or neurological procedures.

Types of nonabsorbable sutures

Some examples of nonabsorbable sutures can be found below. These types of sutures can all be used generally for soft tissue repair, including for both cardiovascular and neurological procedures.

Nylon. A natural monofilament suture.
Polypropylene (Prolene). A synthetic monofilament suture.
Silk. A braided natural suture.
Polyester (Ethibond). A braided synthetic suture.

You’ll often see sutures and stitches referred to interchangeably. It’s important to note that “suture” is the name for the actual medical device used to repair the wound. The stitching is the technique used by your doctor to close the wound.

Suture material is graded according to the diameter of the suture strand. The grading system uses the letter “O” preceded by a number to indicate material diameter. The higher the number, the smaller the diameter of the suture strand.

Suture material is also attached to a needle. The needle can have many different features. It can be of various sizes and also have a cutting or noncutting edge. Larger needles can close more tissue with each stitch while smaller needles are more likely to reduce scarring.

Just like there are many different types of sutures, there are many different suture techniques. Some of them are:

Continuous sutures

This technique involves a series of stitches that use a single strand of suture material. This type of suture can be placed rapidly and is also strong, since tension is distributed evenly throughout the continuous suture strand.

Interrupted sutures

This suture technique uses several strands of suture material to close the wound. After a stitch is made, the material is cut and tied off. This technique leads to a securely closed wound. If one of the stitches breaks, the remainder of the stitches will still hold the wound together.

Deep sutures

This type of suture is placed under the layers of tissue below (deep) to the skin. They may either be continuous or interrupted. This stitch is often used to close fascial layers.

Buried sutures

This type of suture is applied so that the suture knot is found inside (that is, under or within the area that is to be closed off). This type of suture is typically not removed and is useful when large sutures are used deeper in the body.

Purse-string sutures

This is a type of continuous suture that is placed around an area and tightened much like the drawstring on a bag. For example, this type of suture would be used in your intestines in order to secure an intestinal stapling device.

Subcutaneous sutures

These sutures are placed in your dermis, the layer of tissue that lies below the upper layer of your skin. Short stitches are placed in a line that is parallel to your wound. The stitches are then anchored at either end of the wound.

When your sutures are removed will depend on where they are on your body. According to American Family Physician, some general guidelines are as follows:

scalp: 7 to 10 days
face: 3 to 5 days
chest or trunk: 10 to 14 days
arms: 7 to 10 days
legs: 10 to 14 days
hands or feet: 10 to 14 days
palms of hands or soles of feet: 14 to 21 days

To remove your sutures, your doctor will first sterilize the area. They’ll pick up one end of your suture and cut it, trying to stay as close to your skin as possible. Then, they’ll gently pull out the suture strand.

You may have heard the word “sutures” in reference to a bone or bones. This is because the area where the bones of your skull meet is called a suture. Your skull has many of them. They allow the skull to increase in size throughout development and then fuse together when growth is complete. This is not related to the sutures that a physician or surgeon may place to close a wound.

Sutures are used by your doctor to stitch shut wounds or lacerations. There are many different types of suture materials available. Additionally, there are many suture techniques that can be used. Your doctor will choose both the correct suture material and technique to use for your condition. Talk to your doctor about any concerns you have about sutures before your procedure.

Last medically reviewed on April 5, 2018

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Common suture materials and suggested indications for their use. (n.d.).
oxfordmedicaleducation.com/clinical-skills/procedures/common-suture-materials-and-suggested-indications-for-their-use/
Forsch RT. (2008). Essentials of skin laceration repair.
aafp.org/afp/2008/1015/p945.html
Suturing basics. (n.d.).
bumc.bu.edu/surgery/training/technical-training/suturing-basics/
Suture materials. (n.d.).
meds.queensu.ca/central/assets/modules/basic_suturing/suture_materials.html
Types of suture: Suture materials. (n.d.).
dolphinsutures.com/types-of-sutures
Wound closure manual. (n.d.).
uphs.upenn.edu/surgery/Education/facilities/measey/Wound_Closure_Manual.pdf

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Medically reviewed by Andrew Gonzalez, M.D., J.D., MPH — By Jill Seladi-Schulman, Ph.D. — Updated on April 6, 2018

How Long They Last, Complications, Removal, Care

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Oral surgery

Dissolvable stitches are used after tooth extraction, such as wisdom tooth removal, to tack the gum tissue flap back into its original place. A curved suture needle is used, and the number of stitches required is based upon the size of the tissue flap and each individual’s needs.

Cesarean delivery

Some doctors prefer staples while others prefer dissolvable stitches after cesarean delivery. You may wish to discuss the pros and cons of each with your doctor prior to your delivery to determine which type is best for you.

A randomized, clinical trial conducted at three U.S. hospitals found that women who had C-sections with dissolvable stitches had a 57 percent decrease in wound complications over women who had their wounds closed with staples.

Breast cancer tumor removal

If you have breast cancer, your surgeon will remove the cancerous tumor, surrounding tissue, and possibly several lymph nodes. If they use dissolvable stitches, the stitches will be placed in areas where scarring can be reduced as much as possible.

Knee replacement surgery

Knee surgery, including knee replacement surgery, may use dissolvable stitches, nondissolvable stitches, or a combination of the two. In some instances, a line of dissolvable stitches will be used under the skin to reduce surface scarring.

A material that’s commonly used for dissolvable stitches in orthopedic surgeries, like knee surgery, is polydioxanone. These stitches can take about six months to completely dissolve.

It’s not unusual for a dissolvable stitch to poke out from under the skin before it has completely dissolved. Unless the wound has opened, is bleeding, or shows signs of infection, this is not cause for alarm.

Unlike with permanent sutures, dissolvable ones are much less likely to create stitch reactions such as infection or granulomas.

Signs of infection include:

redness
swelling
oozing
fever
pain

You may be tempted to try to cut or pull the stitch out, but your wound may not have fully healed. It’s better to have patience and let the process take its course. Let your doctor know about your concerns.

Also, ask your doctor how long the dissolvable stitches are designed to remain intact for your specific procedure.

If more time than that has passed, they may recommend you come in to have the stitch snipped or can let you know if you can remove it yourself.

Dissolvable stitches that poke through the skin may fall off themselves, perhaps in the shower from the force of the water or by rubbing against the fabric of your clothing. That’s because they’re continuing to dissolve under your skin.

As mentioned above, it’s important not to remove a dissolvable stitch on your own without getting your doctor’s approval first.

If you doctor approves, make sure to use sterilized equipment, such as a surgical scissor, and to wash your hands thoroughly. You’ll also need to sterilize the area with rubbing alcohol. Check out this step-by-step guide for removing stitches at home.

Wound care instructions given to you by your doctor may include information about keeping the area clean, dry, and covered as well as using antibacterial ointment.

The information given to you will likely include how often to change your wound’s dressing. You may also be told to limit your physical activity.

Follow your doctor’s directions and their wound care instructions carefully, and keep an eye out for signs of infection.

Dissolvable stitches are used for many types of surgical procedures and for wound care. These types of stitches are designed to dissipate on their own, over time.

If you’re having a surgical procedure, ask your surgeon about the type of sutures you’ll receive and how long you can expect them to remain in place.

Be sure to ask about follow-up care and what you should do if a dissolvable stitch doesn’t dissolve on its own.

How to sew knitted products correctly and with what seam (Lessons and MK on KNITTING) – Inspiration of the Needlewoman Magazine

Heading: Lessons and MK on KNITTING

Before sewing knitted fabrics, they must be properly prepared for this. In order for the finished product to have a beautiful presentable appearance and fit well on the figure, you need to sew knitted parts only in the correct sequence and with a suitable knitted stitch. To do this, you need to follow some rules that will be discussed in this article.

The main secrets for connecting parts:

To connect parts, it is better to use the threads from which the knitted fabric is knitted. The exception is unspun threads, decorated, in the form of a cord. In this case, sew the parts with a flat, strong thread of a similar color. Make sure that this thread is strong and does not shed when washed.
It is possible to correctly assemble a product from parts only by observing a strict sequence of all operations. First of all, iron the finished parts and let them dry. Then baste them and measure the product to make sure it fits well.
It is better to perform seams in the following sequence: shoulder, side and sleeve seams. Sew the sleeves into the armholes last. The finishing work is completed.
Do not use too long thread when sewing. It should not be more than 45 cm. The constant friction of the thread on the fabric can cause the thread to break.
Try to keep the thread tension even when sewing. Make sure the seam forms a neat straight line. If the seam is horizontal, focus on the loops of one row, if vertical – on the vertical row of one loop. To help you see the seam line more clearly, run a contrasting basting thread through the desired stitches or row.
If the two flyers you are sewing are slightly different in length, you can eliminate this defect by lightly fitting into the seam. The difference in length should not exceed 1.5 cm. Otherwise, one of the parts will have to be redone.
Product details such as a golf collar or cuffs with a lapel are sewn in a special way. Half of the seam (to the fold of the part) is made on the front side, the rest is on the wrong side. As a result, the edges of the seam will be inside the part and will not be visible.
If you have a long end left from the cast-on edge, you can use this thread. To make a neat connection along the bottom edge, use the suggested technique.

Knit stitch with closed loops

Sewing the details with a knit stitch will make it almost invisible in the product. The parts to be sewn are laid out on a flat surface, if necessary, they can be ironed. The needle is inserted behind the loop located above the closed loops on the upper canvas (Fig. 1). In the same way, the needle is inserted into the loop of the bottom row of the canvas. After a few centimeters, the thread is tightened (Fig. 2).

Knit stitch with open loops

Pick up the dropped loop with a needle, then grab the next loop and pull the thread, after which the loop is thrown off the knitting needle (fig. 3). On the lower part of the bar, a lowered loop is picked up with a needle, and then, inserting the needle from the bottom up, grab the next loop and pull the thread (Fig. 4).

Joining front and back panels

This seam can be used to sew certain parts of the product: back and sleeve, sleeve and front panels.

First, the needle picks up the loop below the closed ones and pulls the thread (Fig. 5). After that, a needle is inserted, the broach is picked up between the edge and the next loop and the thread is pulled out. Repeat this sequence alternately. After a few centimeters, the thread is tightened (Fig. 6).

Vertical seam for the front surface

Place the pieces to be sewn on a flat surface and iron if necessary. The needle is picked up by a broach between the edge and the first loop and the thread is pulled out (Fig. 7). On the other half of the product, the needle picks up the broach between the opposite edge and the next loop and pulls the thread. Alternately repeat these steps on each of the stitched halves. After a few centimeters, the thread is tightened (Fig. 8).

Vertical seam for the wrong side

The seam for the wrong side is sewn in the same way as the seam for the front. The needle is inserted into the broach between the edge and the next loop and the thread is pulled out (Fig. 9). Then the needle is inserted into the broach between the opposite edge and the next loop and the thread is pulled out. After 3 cm, slightly tighten (Fig. 10).

Stitch stitch

This stitch is popular with many knitters. It is quite simple to perform, does not tighten the product and is almost invisible. The seam must necessarily pass below the row of closed loops, otherwise closed loops will be visible on the right side. The needle and thread are inserted between the loops without damaging them. The stitch is led back, the working thread is drawn forward along the wrong side, it is brought out in front of the previous stitch at an equal distance with it. When making a “stitch” seam, it is imperative to turn the product over from time to time and check how the seam looks from the front side (Fig. 11).

Chain stitch

In appearance, chain stitch resembles a chain consisting of air loops (Fig. 12). It is often used when embroidering on knitwear, when processing the neck, armholes and bottom of the product.

When making a chain stitch, the thread is fixed on the wrong side of the fabric. The needle is brought out to the front side, inserted into the hole from where the thread comes out, having previously thrown the main thread from right to left to form a large loop. Then the needle is pulled out, holding the thread with the left hand, and the loop is tightened. To perform the next stitch, the needle is inserted inside the previous one. Each link seems to emerge from the other.

A prerequisite for making a chain stitch is that the stitches exactly match each other in size. Making a chain stitch on the neck of the product will help make it more even and neat.

Having made a tambour stitch, then with a knitting needle or crochet, new loops are knitted from the tambour. From the typed loops, they continue to knit the neck (Fig. 13).

Quilting Stitch

Experienced knitters use the Quilting Stitch to sew on specific pieces: trims, pockets, plackets. In addition, horizontal cuts on the canvas are processed with this seam or the loops of the last row are fixed.

Before pinning the parts of the product, they are well ironed. This makes it easier to work, and the seam is even and neat. The edge of the part that you are going to sew with a kettle seam should end with three or four front rows. Open loops are also carefully ironed.

To sew a quilting stitch, the needle is inserted from the inside into the second loop, then from the top into the first and then pulled out from the bottom up through the third loop. After that, the needle is inserted from top to bottom again into the second loop and pulled through the fourth from the bottom up (Fig. 14).

A neck or trim sewn with a quilting seam retains its shape and beautiful appearance for a long time (Fig. 15).

Special stitch for sewing elastic

A special stitch is suitable for open elastic loops.

Use the waste yarn for two additional rows. Details need to be steamed with wet gauze.

After that, the rows from the auxiliary yarn are removed.

Prepared parts are placed on a horizontal plane. The needle is inserted into the first 2 loops of the lower part.

After pulling up the thread, the needle should be inserted into the 2 corresponding loops of the upper part, continuing to pull up the thread.

After sewing one side of the elastic, close the loops on the other side. Then, having aligned both sides of the elastic, you need to insert a needle into 2 adjacent loops of the lower part. Inserting a needle into 2 corresponding loops of the upper part, you should tighten the thread.

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How to sew knitted products with a needle, basic rules

Knitting or crocheting is an interesting and creative process. Products created in this way are usually distinguished by their attractiveness – they exude warmth and comfort. But there is one detail that can spoil the look of even the most carefully knitted sweater or dress – uneven seams. To prevent this from happening, it is important to master in advance the technique of connecting fragments with a thread and a needle.

How to sew knitwear with a needle?

There are a lot of techniques that allow you to connect parts of similar products to each other. Experienced craftswomen can even come up with something exclusive. But it is important for beginners to know the basics, which we will try to show them. Such seams are considered the simplest and most often used.

“Loop to loop” with open loops

Involves joining parts of the finished item in such a way that the loops are butt. A needle with a thread is inserted into the first extreme loop of the lower part and passed into the same one located at the top. Then the thread is pulled into the next loop. After that, the needle is pulled through the loop of the lower part and removed to the next.

@Premudrosti.in

Closed loops

This stitch is considered the second choice of the first. It is suitable for socks, stockings and other similar products. The execution scheme is as follows:

Closed edges are laid out side by side so that there is no free space.
Outer edges must be on top.
A needle with a thread of a suitable color and density is pierced in half of the edge loop of the lower fragment, the thread is pulled.
After that, the same action is repeated only with the edge loop of the upper fragment, without pulling the thread.
The needle is poked out in the middle of the upcoming stitch, below the finished edge.
Next pierce into the bottom stitch under the closed edge and poke out in the next st.

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Mattress seam

This technology helps to connect side seams or sleeves. Details of things must be placed “face” to the top. A needle with a thread captures the broach of the first edge and a loop makes a free broach. Then, on the second side, they pick up a broach between the edge and the first, pull the thread. Actions are performed in turn: first on one side, then on the other side, until the canvas ends. Finally, the thread is tightened so that the parts are connected to each other without a working transition.

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Weaving stitch

It is considered the most convenient for processing children’s clothing, mittens, hats. At the beginning, you need to insert the needle under the edge loops and go in a similar way in the middle of each loop that follows. The resulting row of stitches may resemble a crawling snake. In the process of creating a seam, it is important to adhere to the principle of the “golden mean”: do not tighten too much and, on the contrary, leave the thread free.