1887

Suture patterns and surgical knots

image of Suture patterns and surgical knots
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Abstract

The selection of an appropriate suture pattern is important to the successful outcome of surgery. The surgeon's aim is to choose a suture pattern that will close the incision and give maximum mechanical support with minimal tissue retraction. Halsted's surgical principles are as applicable during the closure of the incision as they are to its opening. Using the correct suture pattern will help to restore anatomical alignment of tissues, obliterate dead space, minimize tissue trauma and preserve blood supply to the tissues. Perhaps the most vital component of the correct suture pattern is the surgical knot. Tying a secure knot will provide an anchor for the pattern to stay intact and perform its intended purpose. This chapter will review many of the common suture patterns for particular wounds, as well as discussing the importance of knot selection and tying techniques. The following are covered: Classification of patterns; Suture patterns; Rational pattern selection for particular wound closures; and Knot tying. This chapter also includes guides to performing the Two-handed square knot for right-handed surgeons; the One-handed square knot for right-handed surgeons; and the Instrument tie for right-handed surgeons.

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Figures

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22.2 Simple interrupted suture pattern. The appearance of the knot relative to the incision. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.3 Interrupted intradermal suture pattern.  Buried intradermal knot. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.4 Interrupted cruciate suture pattern. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.5 Gambee suture. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.6 Standard simple continuous suture pattern. Running simple continuous suture pattern. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.7 Continuous intradermal (mattress) suture pattern. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.8 Ford interlocking suture pattern. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.9 Lembert suture pattern. Note how this suture inverts the tissues. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.10 Halsted suture pattern. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.11 Cushing suture pattern. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.12 Utrecht suture pattern. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.13 Parker–Kerr oversew. The top picture shows suturing over the haemostat with a Cushing pattern while the bottom shows the Lembert oversew. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.14 Purse-string suture. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.15 Horizontal mattreacss suture pattern. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.16 Vertical mattress suture pattern. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.17 Near and far patternacs. Far-far-near-near.  Far-near-near-far. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.18 Quilled vertical mattress sutures. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.19 Quilled horizontal mattress sutures. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.20 Double butterfly suture pattern. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.21 Modified Mayo suture pattern. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.24 Types of knot.
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22.25 A Chinese finger-trap suture used to secure an active suction drain.
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22.26 Starting an Aberdeen knot. Continuing the Aberdeen knot.
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