2. LEARNING OBJECTIVES
Classify suture patterns based on their effect on tissue
apposition
Describe the steps involved in the accurate placement
of basic suture patterns
Discuss the advantages and disadvantages of various
suture patterns
Visually identify suture patterns
Know when to apply the patterns in Surgery
After the completion of the lesson, each student should be able
to;
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3. Basic Terminology in Suturing a wound
Appositional: Like Layers are apposed
Inverting: Outer Layer Apposed
Everting: Inner Layer Apposed
Throw : Individual phase of knot
Bite: Span of tissue suture encompasses on either side of
incision
Horizontal _____ are parallel to the incision
Vertical ______ are perpendicular to the incision
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S U T U R E P A T T E R N A N D T E C H N I Q U E S
Basic Principle of Suturing
Approximated well with least trauma
Tissues should be handled gently
Stitches should be placed a little away from the
edges of incision without including large tissue mass
Tight placed sutures are prone to high tension and
ischemia
Obliteration of dead spaces should be ensured
Knots should be simple, secured and placed on one
side of the incision line to avoid interference in
healing
5. Classification of Suture Patterns
1.Appositional Suture Patterns: Bring tissues into
close approximation.
2.Inverting Suture Patterns: Turn tissue edges towards
the patient, away from the surgeon, or toward the center
of a hollow organ
3.Everting Suture Patterns: Turn tissues edges outward
away from the patient and toward the surgeon.
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6. Apposing two layers of the Skin
Inverting Suture Pattern Eversion suture Pattern
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7. B. Continuous Suture Patterns
1. Simple continuous
2. Ford interlocking
3. Lambert
4. Connell and Cushing
5. Intradermal pattern
A. Interrupted Suture Patterns
1. Simple Interrupted
2. Horizontal mattress
3. Cruciate
4. Vertical mattress
5. Near and far patterns
Common Suture Patterns Used in Veterinary
Surgery
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8. 1. Interrupted Suture Patterns
A. Simple Interrupted Pattern.
Most basic
Most often used
Insert needle on one side of wound, cross wound, and through tissue on
opposite side
Advantages
Easy to execute
Rapid
Disruption of one suture does not result in
suture line failure
Disadvantages
Excessive tension yields inversion or
eversion
Costly in terms of time and suture (foreign)
material
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9. Cross Mattress Suture Pattern/Cruciate
Pattern
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Advantages
Covers a greater distance per suture than SI, thus saves time
Stronger closure than SI
Resists tension and tissue eversion
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S U T U R E P A T T E R N A N D T E C H N I Q U E S
Simple Continuous Pattern
Similar to Simple Interrupted except the Individual knots are not
applied. Bites are taken from right angle to the Incision line.
Advantages
Conservation of suture compared to SI
Good apposition and a watertight seal
Good for layers under little tension
Disadvantages
If one suture line
breaks, all sutures
will be broken off.
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S U T U R E P A T T E R N A N D T E C H N I Q U E S
Horizontal Mattress Pattern
Advantage.
1. It can be placed in the areas
where much tension is placed
on the skin.
Disadvantage.
1. It interferes with blood
supply to the skin and interferes
with healing.
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S U T U R E P A T T E R N A N D T E C H N I Q U E S
Vertical Mattress Suture Pattern
Near- Near, Far
Far=Perpendicular to the Incision
Line
Advantage.
Doesn't Interfere with blood supply of the skin like HM
Disadvantage.
Consumes more suture materials and consumes more
time.
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Continuous Suture Pattern
1.Simple Continuous Pattern
Similar to Simple Interrupted except this is continuous. No
knots are applied between until incision line is sutured.
Advantage:
Simple and fast with less
requirement of suture material
Disadvantage
If one stitch is untied, rest
stitches can be lost.
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S U T U R E P A T T E R N A N D T E C H N I Q U E S
Continuous Lock Stitch/ Ford Interlocking
Similar to Simple continuous Patter except each stitch is
interlocked
Advantage.
Relative maintenance of
suture strength
Disadvantage
Relatively difficult suture
than previously mentioned.
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S U T U R E P A T T E R N A N D T E C H N I Q U E S
Lambert Suture Pattern /Inverting Suture
Patterns
Primarily indicated to close hollow viscera with large
lumen size such as Rumen, Uterus etc..
Penetrate the serosa, mucularis and submucosa but not the
mucosa of the hollow organ
F-n-f-n
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S U T U R E P A T T E R N A N D T E C H N I Q U E S
Lambert Suture Continued……..
Advantage
Simplest pattern for internal hollow organs.
Relatively rapidly performed, and does not involve mucosa
therefore low risk of contamination.
Disadvantage.
Produces slight stenosis of the organ.
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S U T U R E P A T T E R N A N D T E C H N I Q U E S
Connell And Cushing Suture Pattern
Both pattern are almost same except the Connell pattern
penetrates the Lumen of the hollow organ with each bite while
Cushing only penetrates serosa, mucularis, and submucosa
Bites are placed parallel to
the incision edge
https://www.youtube.com/watch?time_continue
=3&v=mK1I-EWTZIo
https://www.youtube.com/watch?time_continue=22&v=EJS4kEf
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Intradermal Suture Pattern (Continuous)
Bites are placed within the dermis as close to the skin’s
surface as possible
Initial knot is placed at one site of the incision
Final knot is buried under the epidermis
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SURGICSL KNOTS
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S U T U R E P A T T E R N A N D T E C H N I Q U E S
Background
A secure knot is created only when one loop or throw
is placed over another.
The first throw can be made in various ways
depending on the circumstances, and in every case
determines the tension and position of the knot.
The second throw is there only to prevent slippage
and is therefore placed firmly against the first.
Every suture material acts as a foreign body in tissue.
Buried knots are therefore kept as small as possible
and the ends cut short.
However, suture swelling must be borne in mind
when using catgut.
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The most commonly used knots are illustrated:
1. Half-hitch 2. Reef (square) knot
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3. Granny Knot 4. Surgical knot
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Trashi Delek
