SUTURE MATERIAL AND

SUTURING TECHNIQUES -VI

Dr. Archana Kumari

Asstt. Professor cum Junior Scientist
Veterinary Surgery and Radiology
BVC, BASU, Patna
Principle Of Suturing
 Principle of suturing
• The needle should be grasped at approximately 1/3 of the distance from the
eye & 2/3 from point.
• The needle should be pierced the tissue perpendicular to its surface.
• The needle should be placed equidistant (2-3mm) from the incision line. The
depth of penetration should be equal on both side of incision line.
• The needle always passes from –
• The movable tissue to the fixed tissue.
• Thinner tissue to the thicker tissue.
• Deeper tissue to the superficial tissue.
• The tissue never be closed under tension.
• Each suture must be placed 3-4 mm apart from the incision line.
 Suturing techniques
Suture pattern are broadly classified into interrupted suture and continuous
suture. Special sutures used for various purpose may also fall in one of these
two categories.
1) Apposition suture
2) Inversion suture
3) Eversion suture
4) Purse-string suture
5) Relaxation suture
6) Miscellaneous suture
 Apposition suture:

These sutures bring about apposition of wound edges. They are commonly
used for wound on skin, muscles, esophagus etc. e.g. simple interrupted,
simple continuous, lock stitch, subcuticular suture and pin sutute.
(i) Simple interrupted suture
(ii) Simple continuous suture
(iii) Continuous lock-stitch suture
(iv) Sub-cuticular suture
(v) Pin suture
Simple continuous suture
Simple interrupted suture
Continuous lock-stitch suture
 Inversion suture
• In this pattern, the edges of the wound are inverted and brought together.
They are used in hollow visceral organs which have a serous outer coat like
intestine, uterus etc. When sutures the serous surface come in contact with
each other. Inversion, sutures are effective in preventing leakage. e.g.
Lembert’s Czerny’s, Connell and Cushing suture.
• i)Lembert’s suture:The suture passes through serous and muscular layers
but not the mucosal layer. The needle bites at right angle to the suture line.
It may be continuous or interrupted pattern.
• ii)Czerny’s suture:It is double row of lembert’s suture, where one row is
buried by the other row.
• iii)Jobert’s suture: It is just like lembert’s suture. Only difference is
that, it penetrates all the layers. As it pierces all layers, chances of
contamination is more using this suture pattern.
• iv)Cushing suture: This type of suture is almost similar to Lembert’s
suture. the difference is that suture line is parallel to the line of incision,
whereas it is perpendicular in lembert’s suture. It also penetrates the
layers except mucous layer.
• v)Connell suture: The needle penetrates all the layers including mucous
layer. The pattern of suturing is same as cushing.
Jobert’s suture
 Eversion suture
• The edges are everted.
• It is particularly used to suture cut end of the vessels.
• Due to eversion chances of coagulation leading to thrombi or emboli
inside vessel is eliminated.

Purse-string suture
• This suture is used to narrow the lumen of hollow organ and also to
constrict the anal opening after reducing the rectal prolapse.
Purse-string suture
 Relaxation suture
• They are usually used in large animals when there is loss of large tissues
and undue tension is created on the suture line. The tension or relaxation
sutures are placed relaxation at the actual line. Examples are:mattress
suture, quill suture, button suture, near and far suture etc.
• i)Mattress of Halsted suture
• ii)Quill suture: These are vertical mattress suture in which pieces of
quill are placed for equal distribution of tension and to prevent cutting of
skin.
• iii)Button suture: it is also relaxation suture where buttons are used
instead of quill.
Mattress of Halsted suture
Quill suture
• Near and far suture: It is a
modification of a vertical
mattress suture pattern and have
the advantage that is tends to
prevent either inversion or
eversion of the edges of the
incision.
 Miscellaneous suture techniques-
• Tendon suture (Bunnell’s mayer Technique):
• In this technique two small atraumatic straight needles are threaded with
suture material to two swaged on needles are taken.
• The suturing is started on proximal stump from the middle of the severed
or cut end and needle is inserted teansversely through the tendon from the
medial to lateral aspect and then from lateral to medial in a cross manner
upto 2-3 cm proximal to the cut end and then back to the cut end to
complete the first stage of suturing.
• The same procedure is repeated on the distal stump and the knots are tied
together using the free end of the suture of the proximal and distal stumps.
 Nerve suture:
• In the suturing of nerves the fibres are exactly oriented as far as possible
and then the simple interrupted sutures are placed in the epineurium after
applying the stay sutures.

Staple type suture:

• In this technique one edge is placed over the other and sutured.

Retension suture:
• It is used to retain gauze packing inside a wound cavity.
 Parker Kerr suture:
• It is used to anastomose the intestine.
• In this method first the cut ends of the intestine are temporarily closed with
the continuous Lembert’s/Cusing suture by passing the loops of suture over
the intestinal clamp and the sutures are kept temporarily tight.
• The inverted bowel ends are placed together for anastomosis and
continuous Lembert’s/Cusing sutures are applied to approximate the two
segments.
• After finishing the Lembert’s suture the previously placed sutures are
pulled out, the continuity of double row of continuous suture are used to
complete the anastomosis.
 Interrupted Continuous Miscellaneous
1. Simple interrupted Simple continuous Tendon suture

2. Halsted or Mattress Lock stitch Nerve suture

i. Horizontal
ii. Vertical (Glover’s suture)

3. Quill or Button suture Subcuticular Parker-kerr

4. Pin suture Lembert’s Staple stitch

5. Relaxation or tension suture Jobert’s Purse string

6. Near and far Czerny ___

7. ___ Cushing ___

8. ___ Connell ___