1. Advanced Suturing Techniques
Bucky Boaz, ARNP-C

2. Subcutaneous Stitch Deeper wounds or wounds under tension.
Inverted knot.
Begin at bottom of wound edge and come up.
Go straight across incision and down.

4. Running Stitch Indicated for low risk repairs.
Tie knot at one end, do not cut until repair complete.
Faster technique.
Plastic surgery quality.

5. Running Locked Stitch Modified running stitch.
Used to prevent slippage of loops as running stitch continues.
Allows for continuing stitch along irregular laceration.

6. Vertical Mattress Stitch
Promotes eversion of the skin.
Tension or very thick skin.
Enter wound on one side, pierce other side twice, and exit on side entered.

7. Horizontal Mattress Stitch
Needle is introduced in normal fashion.
Second bite is placed ½ cm adjacent to exit site.
Brought back next to original insertion.
Tie knot.

8. Intracuticular running suture
Used to close linear wounds that are not under much tension.
Yields an excellent cosmetic result.
The ends of the suture do not need to be tied.
Taping under slight tension will preserve approximation.

9. Three-point or half-buried mattress suture
Closure of the acute corner of a laceration without impairing blood flow to the tip.

10. Three-point or half-buried mattress suture
Needle is inserted into nonflap portion of the wound at the mid-dermis level; and then at the same level, the suture is passed transversely through the tip and returned on the opposite side of the wound paralleling the point of entrance.

11. Three-point or half-buried mattress suture
The suture is tied, drawing the tip snugly into place in good opposition. This same approach can be utilized in closing a stellate 4- or 5-point laceration, drawing the tips together in a purse-string fashion.

12. Parallel Lacerations
The horizontal technique is used to cross all lacerations
Wound tapes can be used if low tension
If island in middle is wide enough, interrupted sutures can be used

13. Special Anatomic Sites

14. Extramarginal Lid Lacerations
Upper lid lacerations are usually closed with simple interrupted
Intramarginal lid lacerations are best left to plastics

15. Eyebrow lacerations
Most eyebrow lacerations can be closed without tissue debridement
If devitalized, excise tissue parallel to hair shaft

16. Ear 72-hr window to drain perichondral hematoma
Simple noncartilaginous lacerations are closed with interrupted or running sutures
Lacerations involving cartilage

17. Lip Must approximate vermilion border
Through and through lacerations involve orbicularis oris muscle
Repair muscle first
Then, vermillion border
Then, rest

18. Questions?