Wound suturing

Overview of Treatment

Surgical suturing is a technique primarily used to repair lacerations of the skin or tissues, promoting wound healing and reducing scar formation. This method involves stitching the skin edges tightly together to create a stable environment for new cell growth while minimizing the risk of bacterial invasion. Depending on the depth and location of the wound, physicians select different types of sutures and suturing techniques to achieve optimal aesthetic and functional restoration.

This therapy is suitable for acute injuries, surgical incisions, or deep tissue damage caused by accidents. Compared to natural healing, suturing shortens the healing time and improves the accuracy of wound closure, making it one of the fundamental procedures in modern trauma treatment.

Types and Mechanisms of Treatment

Surgical wound suturing mainly falls into the following categories:

• Interrupted sutures: Fixed point-by-point with a single stitch, suitable for skin wounds with less tension
• Continuous sutures: A continuous stitch along the entire length of the wound, often used for linear wounds with uniform tension
• Subcutaneous sutures: Using absorbable sutures to repair deep tissues, with non-absorbable sutures on the surface to close the skin layer

The choice of technique depends on the wound shape, location, and patient-specific factors.

The mechanism involves three stages: firstly, precise tissue approximation to provide physical support; secondly, reducing tissue displacement to promote vascular regeneration; and finally, forming a seal to prevent infection. Absorbable sutures gradually degrade during healing, while non-absorbable sutures need removal after healing.

Indications

Suitable for open wounds, including:

• Deep cuts or lacerations exceeding the superficial skin layer
• Wounds requiring tissue continuity restoration
• Wounds near joints or tendons that require maintaining mobility
• Wounds in cosmetic areas (such as the face) to reduce scarring

Additionally, some surgical incision closures also require suturing to ensure tissue approximation.

Note that this therapy is not suitable for infected wounds or areas with poor circulation. The physician will perform debridement and disinfection first, confirming the wound is clean before suturing to avoid complications.

Application Method and Dosage

The treatment process includes four main steps:

1. Local anesthesia: via local injection or topical anesthetic gel to numb nerve endings
2. Debridement: removing foreign objects, necrotic tissue, and controlling bleeding
3. Selection of suture type: choosing absorbable or non-absorbable sutures based on wound characteristics
4. Suturing operation: using a specialized needle to perform interrupted or continuous sutures

The procedure duration depends on the wound size, typically about 15-30 minutes for small wounds.

There is no concept of 'dosage,' but the suturing density should be adjusted according to tension. For example, facial wounds usually use fine sutures of 5-0 to 7-0 to minimize scars, while wounds around joints require more sutures to resist pulling forces.

Benefits and Advantages

Main benefits include:

• Accelerating wound healing, shortening natural healing time by 7-10 days
• Reducing bacterial invasion risk, with infection rates lowered to 1-3%
• Creating even wound edges, reducing prominent scar formation
• Maintaining tissue structural integrity, especially important in muscle or tendon injuries

This method is regarded as the gold standard in emergency medicine.

Cosmetically, the results are especially significant, with facial scars reduced by 40-60%. For functional wounds (such as around joints), suturing can restore joint mobility and prevent subsequent functional impairment.

Risks and Side Effects

Potential risks include:

• Infection: incomplete debridement may lead to cellulitis (incidence about 2-5%)
• Abnormal scarring: such as keloids (more common in individuals with darker skin)
• Suture reaction: about 10% of patients may develop allergic or inflammatory responses to suture materials
• Tissue necrosis: excessive tension in sutures may impede blood supply

Emergent complications include persistent redness, swelling, pus, or fever.

Short-term side effects commonly observed:

• Minor swelling at the suture site (usually subsides in 3-5 days)
• Temporary pigmentation changes (recovery in about 6-8 weeks)
• Itching caused by suture crusting

Physicians often use prophylactic antibiotics to reduce risks based on patient conditions.

Precautions and Contraindications

Absolute contraindications include:

• Infected wounds that are uncontrolled
• Coagulopathy (such as hemophilia)
• Diabetic patients with poor glycemic control

Relative contraindications include severely contaminated wounds or patients allergic to suture materials.

Postoperative care is crucial:

• Ice packs within 24 hours to reduce swelling
• Avoid water contact for at least 48 hours
• Weekly observation of wound healing progress

Patients must strictly follow cleaning and dressing instructions, as non-compliance increases infection risk by 3-5 times.

Interactions with Other Treatments

Be aware of drug interactions:

• Anticoagulants (such as warfarin) may increase bleeding risk
• Steroid use may delay healing
• Antibiotic ointments may react chemically with some absorbable suture materials

Physicians will evaluate the patient's medication history before treatment.

Interactions with other therapies:

• Combining with debridement surgery can improve success rates
• Using tissue expanders requires at least a 2-week interval
• Wounds after radiotherapy should be delayed in suturing

Complex cases require multidisciplinary assessment.

Treatment Outcomes and Evidence

Clinical studies show that properly performed suturing can accelerate wound healing by 40-60% and reduce scar width by over 50%. The American Surgical Association reports that infection rates can decrease from 15% to below 3% compared to natural healing.

Cosmetically, subcutaneous suturing techniques in facial trauma achieve patient satisfaction rates over 85%. Long-term follow-up indicates that properly sutured wounds can hide scars within skin textures after 6-12 months, and functional wounds recover over 90% of tissue strength.

Alternatives

Alternative methods include:

• Skin adhesives: using cyanoacrylate glue, advantageous for superficial wounds less than 0.5cm deep, avoiding suture removal
• External fixators: using metal clips or adhesive tapes to secure the skin, suitable for children or those afraid of suture removal
• Tissue gluing: combining biological glue with minimally invasive techniques, but with higher infection risks

Selection of alternatives should consider:

• Wound depth and tension
• Patient allergy history to sutures
• Cosmetic priorities

For example, facial wounds prefer absorbable sutures, while knee joint wounds may require reinforced suturing techniques.

 

Frequently Asked Questions

How long after suturing can I shower normally? What steps should I follow?

It is generally recommended to avoid direct water contact until the wound is fully healed, usually 3-5 days. For cleaning, gently pat around the wound with a clean, dry towel, avoiding rubbing. After removing sutures, if there are no abnormalities, you can shower carefully, but immediately dry the area with a clean gauze and apply an antibacterial ointment as instructed by your doctor.

Is redness, swelling, heat, or pain after suturing normal? When should I seek immediate medical attention?

Minor redness and swelling may be normal healing responses, but if accompanied by severe pain, pus, or fever, it may indicate infection. If inflammatory symptoms worsen after 48 hours or if there is spreading redness around the wound, return for examination. Antibiotics may be necessary.

How does the removal time of sutures vary in different areas?

The removal time depends on the wound location, e.g., 5-7 days for facial skin, 10-14 days near joints, and longer for surgical incisions. If absorbable sutures are used, the absorption time depends on the material, and the physician will adjust the removal timing based on healing progress.

How can I prevent obvious scars after suturing?

During early healing, avoid direct sunlight exposure on the wound and use SPF30 or higher sunscreen when outdoors. After healing, silicone gel sheets or gels can be used to reduce scars, and avoid excessive tension on the wound. For hereditary scar-prone individuals, the physician may recommend post-operative steroid injections or laser treatments to minimize scars.

What are the conditions and timing for secondary suturing (secondary alignment)?

If the initial suturing results in wound dehiscence or infection, secondary suturing is necessary. Usually, wait until acute inflammation subsides (about 3-7 days), then perform debridement and disinfection before suturing again. This procedure should be done in a sterile environment and may involve antibiotics to enhance healing success.