Suture Materials and Techniques

We use atraumatic cutting needles for the skin, and we generally use round needles for the mucosa. Our suture material of choice for the face is 6-0 or 7-0 monofilament on a very fine needle. Occasionally we use 5-0 monofilament for areas that are not visible. Prolene®, PDS®, P1 and P6 5-0 needle with P3 or PS 3 needle.

Our subcutaneous sutures are composed of ab-sorbable or fast-dissolving braided or monofilament material. Vicryl or PDS, P1, P3 needle Ethicon, Norderstedt, Germany.

A suture or suture line must remain in place only until the wound has healed to an adequate tensile strength. Leaving sutures in too long results in ugly scarring of the needle tracks. Sutures are removed as early as possible. Sutures in the eyelid area or near the border of the lip should be removed on the fifth postoperative day, sutures in other facial areas on day five or six. If sutures have been placed under tension, we remove them on day seven or eight. Sutures in the posterior auricular surface are removed on day eight. The simple interrupted suture (Fig. 2.1) is most commonly used. Each surgical knot should be tied with at least two or preferably three throws tied in opposite directions.

We generally use continuous sutures (Fig. 2.2) for the lid area, for long traumatic wounds, and behind the ear in auricular reconstructions. After every three or four stitches we usually tie an intermediate knot to obtain a secure coaptation.

The tightened suture should raise the wound edges slightly so that the scar will be at skin level following scar contraction. With deep wounds, a subcutaneous approximating suture is placed initially with a buried knot (Fig. 2.1a, b).

In areas where two skin incisions meet at an angle, we generally use a Donati or Allgower type of vertical mattress suture to coapt the wound edges (Fig. 2.3). Wounds under tension are additionally reinforced with mattress sutures tied over ointment-impregnated gauze or silicone button (Fig. 2.4). These sutures are removed in 7-10 days.

Plastic Surgery Sutures

Fig. 2.1 Simple interrupted suture.

a Subcutaneous approximating suture of absorbable material, with a buried knot. b The entrance and exit points are placed symmetrically. c The suture is tightened, slightly pursing the wound margins, and is tied on one side.

Fig. 2.1 Simple interrupted suture.

a Subcutaneous approximating suture of absorbable material, with a buried knot. b The entrance and exit points are placed symmetrically. c The suture is tightened, slightly pursing the wound margins, and is tied on one side.

Images Simple Continues Sutures
Fig. 2.2 Over-and-over continuous suture.
Donati Allgower Stitch Allgower Donati

Fig. 2.3 a Vertical mattress suture (Donati type). b Vertical mattress suture (Allgower type).

Pursing Suture

Fig. 2.4a Mattress sutures can be used to reinforce a suture line that is under tension. The monofilament threads are tied over bolsters consisting of swabs, silicone tubing, etc. b Schematic view in cross section.

Fig. 2.4a Mattress sutures can be used to reinforce a suture line that is under tension. The monofilament threads are tied over bolsters consisting of swabs, silicone tubing, etc. b Schematic view in cross section.

Plastic Surgery Suture Types
Fig. 2.7a Instruments for facial surgery (see text; from K. Storz, Tuttlingen, Germany).

The continuous intracutaneous suture can yield a more favorable cosmetic result in many surgical procedures (Fig. 2.5). We use 4-0 or 5-0 monofilament material for this type of suture. Adhesive strips can be added to the sutures to further relieve tension on the wound edges and ensure a cosmetically acceptable scar. The Gillies corner suture is used in angled suture lines and for the dispersion of scars (Fig. 2.6a). The needle is passed subcutaneously through the wound angle and brought out on the opposite side (Fig. 2.6b).

How To Reduce Acne Scarring

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Responses

  • johanna
    How to suture in plastic surgery?
    1 year ago
  • Damian Aitken
    What suture material facial laceratin?
    6 months ago

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