Suturing Procedure

Definition: The application of stitch on body tissues with the surgical needle & thread.

Purpose
• To approximate wound edges until healing occurs
• To speed up healing of wound
• To minimize the chance of infection
• For esthetic purpose

Equipment
• Tray or trolley covered with a sterile towel
• Sterile needle holder
• Sterile round needle (2)
• Sterile cutting needle (2)
• Sterile silk
• Sterile cat- gut
• Sterile tissue forceps
• Sterile suture scissors
• Sterile cotton swabs in a galipots
• Sterile solution for cleaning
• Sterile dressing forceps
• Sterile receiver
• Sterile gauze
• Sterile plaster
• Dressing scissors
• Local anesthesia
• Sterile needle & syringes
• Sterile gloves
• Sterile hole- towel (Fenestrated towel)

Procedure
• Explain procedure to patient
• Adjust light
• Wash your hands
• Clean the wound thoroughly
• Wash your hands again
• Put on sterile gloves
• Drape the Wound with the hold- sheet
• Infiltrate the edges of the wound to be sutured with local anesthesia.
• Approximate the edges of the fascia with the help of the tissue forceps and using the round needle and cat- gut. Suture the fascia layer first.
• Using the cutting needle and silk, suture the outer layer of skin approximating the edges with the help of the tissue forceps.
• Clean with iodine and cover with sterile gauze.
• Remove the hole- Sheet
• Make patient comfortable
• Remove all equipment, wash & return to its proper place or send for sterilization.

Note:
• Do not suture wounds that are over 12 hrs old. How ever, such wounds have to be seen by a doctor since excision of all dead & devitalized tissue and eventual suturing may be required.
• Check that the patient gets his order for T.A.T before he leaves the hospital.
• Do not suture deep wound.
• Before you suture any wound, make sure it is free of any foreign bodies.

Removal of the Stitch

Technique: Use aseptic technique

Principles
• Sutures may be removed all at a time or may be removed alternatively.
• Do not cut stitches in more than one place as a part of it may be left behind and may cause infection.
• Suture is lifted slightly by the knot to allow scissors to go under and one part of the suturing from the cleanest part of the wound to the most contaminated part.
• Cleanse the skin around with antiseptic. Remove – gum with benzene or ether and discard the forceps
• Place sterile gauze to receive stitches.
• Take a pair of scissors in the right hand.
• Take a dissecting forceps in the left hand.
• Pull-up gently the knot resting against the skin with the forceps, pass the point of the scissors under the knot then cut the stitch on one side and remove.
• Receive pieces of stitches on a sterile gauze
• Inspect the scar for wound healing and apply iodine on the skin punctures if patient is not sensitive to iodine.
• Apply dressing
• Keep patient comfortable and tide
• Record the state of the wound
• Clean and return equipment to their proper places.