Simple Interrupted Suture Technique: Indications, Step by Step procedure, Common Errors, and Training with Suture Pad

Suturing is a fundamental skill in surgical practice, and the simple interrupted suture technique is one of the most widely used methods in wound closure. This article explores the simple interrupted suture technique, its applications, common errors, and how students and aspiring surgeons can practice and perfect this essential skill using suture pads. 

What is a simple interrupted suture? 

The simple interrupted suture is a versatile technique used for wound closure in a wide range of clinical scenarios. It involves placing individual stitches at regular intervals along the length of the wound. Each suture consists of a knot at the skin’s surface.  

Simple interrupted suture steps 

Here’s a step-by-step breakdown of the simple interrupted suture technique:

Step 1

Grasp the needle holder with your dominant hand and clamp the needle firmly at about two-thirds of its length. Use the nondominant hand to take the forceps and elevate the far side of the wound, close to the intended location for the first stitch.

Step 2

Insert the needle at 90° to the skin surface on the far side of the wound, about few millimiters from the wound, the exact distance depends on the tissue and wound location, a good rule of thumb is about half of the needle length, pushing it according to the needle curvature, ensuring that it passes through all tissue layers. 

Step 3

• Make the needle exit through the wound opening. 
• Hold the needle holder with a firm grip and pull the needle through until enough thread to comfortably perfom the second portion of the suture  

Step 4

• Re-enter with the needle on the near side of the wound, taking care of entering at the same depth the thread comes out at on the far side, then push the needle while rotating the wrist until the needle comes out of the skin on the near side of the wound. 
• When proficient in using two passages, some surgeons prefer passing through both sides in a single movement. 

Step 5

• Equal needle bites of depth and distance from the wound should be taken to allow wound edges to oppose equally and neatly. 
• Hold the needle holder with a firm grip and pull the needle through until you have a short tail (about 2-3 cm) of suture material remaining outside the wound. 

Step 6

Maintain the needle and thread, taking care not to puncture yourself, in your non-dominant hand while holding the needle holder in your dominant hand. Loop the suture material twice around the needle holder, clockwise. With the tip of the needle holder, grasp the tail of the thread and pass it through the two loops you created on the needle holder.   

Step 7

Pull the needle holder toward you while simultaneously pulling your non-dominant hand away, thus establishing the initial knot. 

Step 8

Repeat the operation but, this time, wrap the wire around the needle holder only once in an anti-clockwise direction. Close the knot and repeat a third time, wrapping the thread around the needle holder only once in a clockwise direction. 

Step 9

Cut off the excess thread, leaving about half an inch. Make sure your knot is not placed on the wound, but always on one side.

When to use simple interrupted suture 

The simple interrupted suture technique is employed in various clinical situations, making it an essential skill for medical professionals, including physicians, nurses, and students. Here are some common indications for its use: 

• Lacerations: Simple interrupted sutures are suitable for closing lacerations, including those resulting from accidents, injuries, or surgical procedures.  

• Wound Edges Alignment: This technique is particularly useful when precise wound edge approximation is required to promote optimal wound healing and reduce the risk of infection or dehiscence. 

• Skin Incisions: Surgeons use simple interrupted sutures to close surgical incisions, ensuring that the skin layers are precisely aligned to minimize scarring and optimize cosmetic outcomes. 

• Tendon and Nerve Repair: In some cases, the simple interrupted suture technique is used for the repair of tendons or nerves, depending on the surgeon’s preference and the specific requirements of the case. 

Common Errors in Simple Interrupted Sutures 

Mastering the simple interrupted suture technique requires attention to detail and practice. However, trainees and even experienced practitioners may encounter common errors when performing this technique. Recognizing these errors is the first step in preventing them: 

1. Inadequate Knot Security: Knots may slip or become undone if not tied securely. This can result in wound dehiscence and increased risk of infection. 
2. Uneven Suture Spacing: Unevenly spaced sutures can lead to wound edge misalignment, causing irregular scarring and poor wound healing. 
3. Suture Tension Issues: Inconsistent tension along the suture line can create tissue bunching or gaping, which can affect both wound healing and cosmetic outcomes. 
4. Needle Placement Errors: Incorrect entry and exit points of the needle can lead to tissue distortion and uneven suture alignment. 
5. Excessive Trauma to Tissues: Rough handling of tissues can cause unnecessary tissue damage, leading to prolonged healing and increased scarring. 
6. Inadequate Hemostasis: Failing to address bleeding during the procedure can result in hematoma formation and complications. 
7. Infection Risk: Poor aseptic technique can introduce pathogens into the wound, increasing the risk of postoperative infections. 

Training with Suture Pads

Suture pads, also known as surgical or practice pads, are invaluable tools for learning and mastering the simple interrupted suture technique. They offer a safe and controlled environment for trainees to practice and refine their suturing skills.  

Here’s how to make the most of suture pads for training: 

• Choosing the Right Suture Pad: Select a suture pad that mimics human tissue closely. These pads come in various materials, such as silicone, rubber, or synthetic skin.

• Gathering Necessary Tools: Assemble the required instruments, including needle holders, forceps, scissors, and appropriate suture material. Some suture pads, such as the UpSurgeOn SkinPad, are sold with a complete set of instruments and suture threads.

• Practice Knot-Tying: Start by practicing basic knot-tying techniques on the suture pad. Mastering square knots and surgeon’s knots is essential before progressing to suturing. 

• Needle Handling: Familiarize yourself with proper needle handling, including holding the needle correctly with needle holders and ensuring controlled movements. 

• Suture Placement: Begin suturing on the suture pad, focusing on needle entry and exit points, suture spacing, and suture tension. Strive for even, neat, and precise placement. 

• Tissue Handling: Learn to handle the suture pad tissue gently, simulating the way you would handle human tissue. Avoid excessive trauma and tension. 

• Knot Security: Ensure that your knots are tied securely to prevent them from unraveling. Practice various knot-tying techniques and placements. 

• Progressive Complexity: As your skills improve, challenge yourself with more complex scenarios, such as deeper layers and varying wound shapes. 

• Recording Progress: Record your progress and practice sessions to track improvements and identify areas for further development. 

• Seek Feedback: If possible, practice under the guidance of experienced practitioners who can provide feedback and tips for improvement. 

Conclusion

Mastering the simple interrupted suture technique is a crucial skill for medical professionals involved in wound closure and surgical procedures. Understanding its indications, recognizing common errors, and practicing on hyper realistic suture pads are essential steps in becoming proficient in this technique. With dedicated practice and a commitment to continuous improvement, aspiring surgeons, nurses and medical students can develop the skills necessary to perform simple interrupted sutures with precision and confidence, ultimately contributing to positive patient outcomes and optimal wound healing. 

Authors

Daniele Bongetta

Neurosurgeon

Fatebenefratelli, Milan, Italy

Tommaso Calloni

Neurosurgeon

Fatebenefratelli, Milan, Italy