BASIC AND SPECIAL

SUTURING TECHNIQUES
IN SURGERY

Andrea Ferencz
Semmelweis University, Faculty of Medicine
Department of Surgical Research and Techniques

www.semmelweis.hu/mutettan
 THE PRIMARY GOALS
Medieval period

• Gentle handling of the tissues

• Closing dead space

• Supporting and strengthening wounds until healing

• Approximating wound edges for structural, functional

and an aesthetically pleasing result

• Minimizing the risks of bleeding and infection

THE CHOICE OF SUTURE TECHNIQUE

• Type and anatomic location of the wound

• Thickness of the tissue
• Degree of tension
• Desired cosmetic result in the case of skin
 WOUND CLOSURE
Basic types of sutures
Interrupted sutures: simple interrupted suture
vertical mattress suture (sec. Donati, sec. Allgöwer)
horizontal mattress suture

Running sutures: simple running suture

running-lock suture
running intradermal suture
running vertical mattress suture sec. Donati
running horizontal mattress suture
Special techniques
Clips
Staplers
Wound closure without knotting
ZipLine
Adhesive strips
 BASIC SUTURE TYPES

SIMPLE INTERRUPTED SUTURE

 BASIC SUTURE TYPES

Simple Interrupted Suture

 BASIC SUTURE TYPES

Simple Interrupted Suture - Skin

 BASIC SUTURE TYPES

Simple Interrupted Suture - Skin

 BASIC SUTURE TYPES

Simple Interrupted Suture – fixation of drains

Roman sandal
 BASIC SUTURE TYPES

Simple Interrupted Suture - gingiva

 BASIC SUTURE TYPES

Simple Interrupted Suture - cornea

 BASIC SUTURE TYPES

Simple Interrupted Suture– mikrovessel

1 mm
 BASIC SUTURE TYPES

Simple Interrupted Suture – nerve suture

n. medianus
 BASIC SUTURE TYPES

Simple Interrupted Suture– mesenterium

 BASIC SUTURE TYPES

Simple Interrupted Suture– mesenterium

BASIC SUTURE TYPES

Dehiscence
 BASIC SUTURE TYPES

Evisceration - Disruption – „platzbau”

 BASIC SUTURE TYPES

Simple Interrupted Stithes, as a

retention suture
BASIC SUTURE TYPES

Complications
 BASIC SUTURE TYPES

Vertical Mattress Suture sec. Donati

 BASIC SUTURE TYPES

Vertical Mattress Suture sec. Donati - skin

Mario Donati (1879-1946)

 BASIC SUTURE TYPES

Vertical Mattress Suture sec. Allgöwer

 BASIC SUTURE TYPES

Vertical Mattress Suture sec. Allgöwer - skin

Martin Allgöwer (1917-2007)

 BASIC SUTURE TYPES

Horizontal Mattress Suture

 BASIC SUTURE TYPES

Horizontal Mattress Suture - skin

 BASIC SUTURE TYPES

Horizontal Mattress Suture,

as retention suture
 BASIC SUTURE TYPES

Simple Running Suture

 BASIC SUTURE TYPES

Simple Running Suture - skin

 BASIC SUTURE TYPES

Simple Running Suture – abdominal wall

 BASIC SUTURE TYPES

Simple Running Suture - GIT

 BASIC SUTURE TYPES

Simple Running Suture - uterus

 BASIC SUTURE TYPES

Simple Running Suture - tongue

 BASIC SUTURE TYPES

Simple Running Suture – vessel suture

 BASIC SUTURE TYPES

Simple Running Suture – vessel anastomosis

 BASIC SUTURE TYPES

Simple Running Suture – vessel anastomosis

 BASIC SUTURE TYPES

Simple Running Suture - cornea

 BASIC SUTURE TYPES

Simple Running Suture,

as retention suture
 BASIC SUTURE TYPES

Running-locked Suture
 BASIC SUTURE TYPES

Running-locked Suture - skin

 BASIC SUTURE TYPES

Running-locked Suture - gingiva

 BASIC SUTURE TYPES

Running Intracutan Suture

 BASIC SUTURE TYPES

Running Intracutan Suture - skin

 BASIC SUTURE TYPES

Running Intracutan Suture - skin

BASIC SUTURE TYPES

Complications
SPECIAL TECHNIQUES
SPECIAL TECHNIQUES

Clips - skin
 SPECIAL TECHNIQUES

Linear Staplers - GIT

Hümér Hültl Aladár Petz

(1868–1940) (1888-1956)
 SPECIAL TECHNIQUES

Circular Staplers - GIT

 SPECIAL TECHNIQUES

Staplers – lungs, bronchi, big vessels

a. pulm. sin. v. pulm. superior sin.

 SPECIAL TECHNIQUES

Wound closure with knotless suture

SPECIAL TECHNIQUES

ZipLine® - skin

1936, Kenya
 SPECIAL TECHNIQUES

Steri-Strip Adhesive strips

 SPECIAL TECHNIQUES

Alternative abdominal wall closure techniques

 SPECIAL TECHNIQUES

Ants - skin

Dorylus, army ants Recovered wound

PRACTICE OF THE SUTURES
PRACTICE OF THE SUTURES