Stitches vary in type and size, and in the distance from the edges and from each other, depending upon the circumstances. For closing the skin of large abdominal wounds, they may be 2/0 nylon or polypropylene, placed 5 mm apart,

Figure 6.3. Accommodating disparity in the length of the wound edges by successively halving the wound with sutures.

up to 5 mm from the wound edges. In cosmetically important areas they may be 4-6/0 nylon or polypropylene, placed 2-3 mm from the edge and 2-3 mm apart. The thread is usually mounted in a half circle cutting edge, eyeless needle, held in a needle holder. Each stitch must cross the wound exactly at right angles and emerge at the same distance from the edge as it entered on the opposite side. It should be tied with a reef knot, and an extra half hitch added to form a reef knot with the second hitch. The first hitch should be tightened just sufficiently to appose the edges, the second just to secure it, and the third tightly, otherwise the first hitch will be overtightened, with consequent ischaemia. The ends should be cut short so they do not interfere with subsequent stitches. Stitches may be interrupted or continuous. Each

Longitudinal Suture
Figure 6.4. Everting mattress sutures. (a) vertical section through a longitudinal mattress suture. (b) View of a longitudinal mattress suture.

type has advantages and disadvantages; the use of one or the other is a matter of personal choice.

If the skin edges tend to invert, they can be everted using mattress sutures. These are double stitches that may cross the wound parallel to each other (horizontal mattress, or in the same line) vertical mattress (Fig. 6.4). These stitches must be removed at varying times. On the face they can often be removed after 48 h to avoid producing ladder-type marks across the scar. On the other hand, abdominal wound skin stitches are sometimes left in for 8-10 days.

Subcuticular stitches avoid the cross marks that may mar a scar sutured conventionally (Fig. 6.5). Non-absorbable monofilament nylon or polypropylene is inserted through the skin about 5 mm from one end of the wound to emerge through the deeper part of the skin in the angle of the wound. It then takes horizontal bites of the deep epidermis on alternate sides until the far end is reached. The needle is then passed through the far angle to emerge on the surface about 5 mm from the end of the wound. The two ends of the suture are then drawn apart to tighten the stitch and draw the skin edges together. The suture ends can be taped to the skin at each end. When the suture is to be withdrawn, it is gently tautened and freed by gently drawing on the ends alternately, then pulling through intact from one end.

Absorbable subcuticular sutures, for example, metric 1 or 1.5 (5/0 or 4/0) multifilament polyglactin 910 or polyglycolic acid, do not need to be removed. A subcuticular stitch at one end, uniting both sides, begins the process, then a knot should be tied, which will be buried. The subcuticular suture is then inserted until the other end is reached, a loop being retained before the last encircling stitch is inserted, catching both sides. This loop is then tied to the thread end, forming a knot that will be buried.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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