Respond to the 2 following discussion posts separately with separate reference lists. References to be no older than 5 years.
1.Lindsay Trent posted Sep 29, 2022 8:58 AM
Suturing is a technique that has been around for thousands of years to close cutaneous wounds (Ratner, 2020). The primary goals of suturing have remained the same: closing dead space, supporting and strengthening wounds until healing increases tensile strength, approximating skin edges for an aesthetically pleasing and functional result, and minimizing the risks of bleeding and infection (Ratner, 2020). There are multiple suturing techniques, and the choice depends on the type and location of the wound, thickness of the skin, degree of tension, and desired cosmetic result (Ratner, 2020). Suture techniques include simple interrupted, simple buried, vertical mattress, horizontal mattress, figure-of-8, half-buried, simple running, simple running locking, and subcuticular running (Zenn, 2013). Interrupted sutures are the most common and easy to place, have high tensile strength, and decrease the risk of edema and impaired circulation (Ratner, 2020; Zenn, 2013). However, interrupted sutures take longer to place and can often cause crosshatched marks or scarring across the suture line (Ratner, 2020). Simple buried sutures are the main suture that will be used when deep sutures are needed before skin sutures; for these sutures, it is important to start deep and end superficially to avoid buttonholing the skin (Zenn, 2013). Simple running sutures are more appropriate for longer wounds with deeper placed sutures that have already minimized wound tension whereas running locked sutures have increased tensile strength (Ratner, 2020). Vertical and horizontal mattress sutures maximize wound eversion, reduce dead space, and minimize tension across the round (Ratner, 2020). Half-buried vertical and horizontal mattress sutures are reserved for cosmetically important areas such as the face and provide better cosmetic outcomes (Ratner, 2020). Running subcuticular sutures can be used when space is minimal and dead space has been eliminated; the epidermis is only penetrated at the beginning and end of the suture line, minimizing crosshatching and provided the best possible cosmetic outcome (Ratner, 2020). In general, the success of any suturing technique has a lot to do with appropriate selection of sutures, needles, and needle holders (Ratner, 2020). The technique that is selected should allow for the smallest suture that will adequately hold the wound edges while ensuring the tensile strength of the suture does not exceed the tensile strength of the tissue (Ratner, 2020).
References
Ratner, D. (2020). Suturing techniques. Background, Indications, Technical Considerations. Retrieved 2022, from https://emedicine.medscape.com/article/1824895-overview#a3
Zenn, M. (2013). Learn How To Suture – Best Suture Techniques and Training. YouTube. Retrieved 2022, from https://www.youtube.com/watch?v=TFwFMav_cpE.
2. Judy Nguyen posted Sep 28, 2022 6:51 PM
Suture is considered a standard of care in primary wound closure. It is helpful in minimizing bleeding and aides wound in the healing process (Azmat & Council, 2020). The purpose of sutures is to reduce the dead space between the wound opening and provide the necessary support needed for the skin heal appropriately. Before the suturing process, the provider must evaluate the skin and wound type, the degree of tension, as well as the anatomical location. It is also important to ask for patient’s preferences and what their desire cosmetic skin results (Azmat & Council, 2020). It is essential to acknowledge infection risk and inflammatory reaction associated with the suture material prior to using the appropriate suture for wound closure (Azmat & Council, 2020).
There are two different types of sutures; absorbable and non-absorbable. Absorbable sutures are intended to stay inside the body after closure and will absorb overtime, they do not require a provider to remove them, whereas, non-absorbable sutures do not degrade and will need to be removed later (Gonzalez, 2018).
There are various types of suture selections techniques that can be used when suturing. Continuous suturing involves a single strand of suture material but include a series of stitches. This can be done fast compared to other sutures and is evenly distributed throughout the entire wound. They can be used on the dermis or in internal organs such as the uterus. They are great for achieving hemostasia. Interrupted sutures are the most common in skin wound and are done one closure at a time. Single, vertical, horizontal, and pulley are different approaches to interrupted sutures. Deep sutures are a type of suture that is placed under the layers of tissue below the skin. Buried sutures are done by using absorbable sutures and not able to be seen from the outside as they are buried under the skin. It can be done single or continues. Purse-string sutures are a continuous suture placed around an area and tightened like the drawstring. Lastly, subcutaneous sutures are placed in the dermis and subcutaneous tissue, which lies below the upper layer of the skin (Gonzalez, 2018).
References
Azmat, C., Council, E., (2020) Wound closure techniques. StatPearls Retrieved
from https://www.ncbi.nlm.nih.gov/books/NBK470598/
Gonzalez, A. (2018). Everything you need to know about surgical sutures. Retrieved
from https://www.healthline.com/health/sutures#types
