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Laceration Repair: Simple Interrupted Sutures

  • Editor(s): Todd W Thomsen, MD, Gary S Setnik, MD, FACEP
  • Section Editor(s): Phillip M Harter, MD
  • Contributor(s): Carmie Chan, MD
PRE-PROCEDURE
INDICATIONS
  • Traumatic skin wound (See Basics of Wound Management for further details).
CONTRAINDICATIONS
  • Extended interval between injury and repair
  • Other factors to consider:
    • The patient's age and state of health
    • Potential for foreign bodies to be embedded in the wound
    • Associated injuries to underlying structures
    • The degree of contamination
  • Delayed Primary Closure
EQUIPMENT

Many institutions stock prepackaged laceration trays that contain most of the necessary equipment:

  • Skin cleansing agent, such as chlorhexidine
  • Sterile gauze
  • Local anesthetic
  • 5- or 10-mL syringe
  • 25-gauge needle for anesthetic injection
  • Saline solution
  • 30- to 60-mL syringe with splash guard for irrigation
  • Sterile bowl
  • Sterile drape
  • Needle holder
  • Toothed forceps (Adson Brown)
  • Suture scissors
  • Suture material
ANATOMY

Wound healing

  • The initial phase of wound healing during days 0-5 is the inflammatory phase.
  • Within 48 hours, the epithelium regenerates and closes off the external surface of the wound.
  • The fibroblast phase begins around 48 hours after injury; during this phase, collagen formation occurs, giving the wound repair strength.
  • Collagen production reaches its peak about 7 days later and has the most mass at 3 weeks after injury.
  • The wound will continue to strengthen over the next year.
Laceration repair.
Figure 1 :  Laceration repair.

Grossly contaminated hand laceration.
Figure 3 :  Grossly contaminated hand laceration.

Equipment.
Figure 4 :  Equipment.

Table 1 : 

Table 1 : 

Table 2 : 

Table 2 : 

Table 3 : 

Skin anatomy. Adapted from Robinson JK, Anderson ER: Skin structure and surgical anatomy. In Robinson JK, Hanke WC, Sengelmann R, Siegel D: Surgery of the Skin. Philadelphia, Mosby, an imprint of Elsevier, 2005, p. 4.
Figure 8 :  Skin anatomy. Adapted from Robinson JK, Anderson ER: Skin structure and surgical anatomy. In Robinson JK, Hanke WC, Sengelmann R, Siegel D: Surgery of the Skin. Philadelphia, Mosby, an imprint of Elsevier, 2005, p. 4.


PROCEDURE
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Prepare the surrounding skin with antiseptic.
Figure 10 :  Prepare the surrounding skin with antiseptic.

Irrigate with normal saline.
Figure 12 :  Irrigate with normal saline.

Explore the wound.
Figure 13 :  Explore the wound.

Evert the wound edge with the forceps without pinching the tissues, and enter the skin in a perpendicular fashion.
Figure 15 :  Evert the wound edge with the forceps without pinching the tissues, and enter the skin in a perpendicular fashion.

To begin the knot, place the needle driver parallel over the laceration.
Figure 17 :  To begin the knot, place the needle driver parallel over the laceration.


POST-PROCEDURE
CARE
  • Apply a wound dressing.
  • Immobilize the injury.
  • Prophylactic antibiotics, when indicated
  • Tetanus prophylaxis
  • Thorough discharge instructions should be provided for the patient. These are reviewed in the Basics of Wound Management chapter. (See Basics of Wound Management for further details.)
  • Suture removal
  • Remove sutures on the face on the fifth day following the injury, or remove alternate sutures on the third day and the remainder on the fifth day.
  • On the extremities and the anterior aspect of the trunk, leave sutures in place for approximately 7 days to prevent wound disruption.
  • Leave sutures on the scalp, back, feet, and hands and over the joints in place for 10 to 14 days, even though permanent stitch marks may result.
COMPLICATIONS
  • Foreign body reaction to suture
  • Improperly sized needle
  • Excessive tension on sutures
  • A further discussion of complications encountered in wound repair, such as infection and scarring, can be found in the Basics of Wound Repair Chapter (see Basics of Wound Management, for further details).
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