๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
The Simple Interrupted Suture Step-by-Step
The Simple Interrupted Suture Step-by-Step
a. The needle is inserted perpendicular to the epidermis, approximately one-half the
radius of the needle distant to the wound edge. This will allow the needle to exit the wound on the contralateral side at an equal distance from the wound edge by simply following the curvature of the needle. b. With a fluid motion of the wrist, the needle is rotated through the dermis, taking the
bite wider at the deep margin than at the surface, and the needle tip exits the skin on the contralateral side. c. The needle body is grasped with surgical forceps in the left hand, with care being
taken to avoid grasping the needle tip, which can be easily dulled by repetitive friction against the surgical forceps. It is gently grasped and pulled upwards with the surgical forceps as the body of the needle is released from the needle driver. Alternatively, the needle may be released from the needle driver and the needle driver itself may be used to grasp the needle from the contralateral side of the wound to complete its rotation through its arc, obviating the need for surgical forceps. d. The suture material is then tied off gently, with care being taken to minimize
tension across the epidermis and avoid overly constricting the wound edges.
It is important to enter the epidermis at 90 degrees, allowing the needle to travel slightly laterally away from the wound edge before fully following the curvature of the needle when utilizing this technique. This will allow for maximal wound eversion and accurate wound-edge approximation. The final cross-sectional appearance of the needleโs course should be a flask-like shape, wider at the base than at the surface.
Care should be taken to avoid skimming the needle superficially beneath the epidermis. This results from failing to enter the skin at a perpendicular angle and failing to follow the curvature of the needle. This may result in wound inversion as the tension vector of the shallow bite pulls the wound edges outwards and down.
This technique may elicit an increased risk of track marks, necrosis, and other complications when compared with techniques that do not entail suture material traversing the scar line, such as buried or subcuticular approaches. Therefore, sutures should be removed as early as possible to minimize these complications, and consideration should be given to adopting other closure techniques in the event that sutures will not be able to be removed in a timely fashion. Some studies have also demonstrated an increased rate of dehiscence when utilizing interrupted sutures alone without underlying dermal tension-relieving sutures, highlighting that this technique
should be used either for wounds under minimal tension or in concert with deeper tension-relieving sutures.21โ26