SUTURE -DEFINITION
Suturing is the joining of tissues with needle and “thread,” so that thetissues bind together and heal. The “thread” is actually specializedsuture material.Health care providers frequently encounter wounds in need of suturing, and it is important to become proficient. You can practice your su-turing skills on pigs’ feet, available at a butcher shop. This chapter givesyou all the necessary information to perform basic suturing,
including:
• Types of needles and suture material
• Selection of material for various wounds and situations
• Techniques

SUTURE NEEDLES
There are two broad classifications of needles: curved and straight.
A straight needle can be used without instruments. A curved needle must be handled with forceps and a needle holder.Although hand sewing with a straight needle does not require forceps,the technique is cumbersome and entails a much higher risk of accidentally sticking yourself. Hence, suturing with a straight needle is uncommon and not recommended if curved needles are available. Generally, forceps and needle holders are available, and a curved needle is used for suturing.
There are two types of curved needles.
Cutting Needle- A cutting needle is used primarily for suturing theskin. It has a very sharp tip with sharp edges, which are needed to passthrough the skin. Since you will place primarily skin sutures, you gen-erally will use a cutting needle.
Tapered Needle- Tapered needles, or “round-bodied” needles, havea sharp tip with smooth edges and are less traumatic to the surround-ing tissues. They are used primarily on the deeper, subcutaneous tis-sues, blood vessels, and intestinal anastomoses. A tapered needle is notgood for simple skin suturing because it is difficult to pass the tapered needle through the skin.

SUTURE SIZES
Sutures come in various sizes. The bigger the suture material, usually the bigger the needle. The sizing of sutures is similar to the sizing of needles for injection: the bigger the number, the smaller the size of thesuture.
Suture sizes range from 00 (very large, used to close the abdominal wall—about the size of large fishing line) to 10-0 (very tiny, usedfor microvascular anastomoses—as fine as a human hair). You generally will use sizes in the middle range: 3-0 to 5-0.It is best to use small sutures on the face, such as 5-0 or 6-0. Smaller su-tures are associated with decreased scarring, which is a concern withfacial wounds. On areas where cosmetic concerns are less important, 3-0 or 4-0 sutures are best, because the larger size makes the technique easierand the thicker sutures are stronger. The tendency is to use smaller su-tures on children because of their more delicate skin. Rarely do youneed anything larger than a 4-0 suture.

SUTURE MATERIALS :-
Many different suture materials are available. The main classificationsare absorbable or nonabsorbable. A more subtle subclassification iswhether the suture material is braided or nonbraided.Unless there is a dire emergency, never use regular thread for suturesbecause of the risk of infection.
Nonabsorbable Sutures
Nonabsorbable sutures remain in place until they are removed.Because they are not dissolved by the body, they are less tissue-reactiveand therefore leave less scarring as long as they are removed in atimely fashion. They are best used on the skin.
Absorbable Sutures
Absorbable sutures are dissolved by the body’s tissues. The great advantage is that the sutures do not need to be removed. However, ab-sorbable sutures tend to leave a more pronounced scar when used asskin sutures. Absorbable sutures are primarily used under the skin,where they are well hidden.
It is sometimes difficult to get patients to return for suture removal. Ifthis is a concern, use an absorbable suture for skin closure. You shouldwarn the patient that absorbable sutures probably will result in a morenoticeable scar than nonabsorbable sutures with later removal.
Because it is often difficult to remove stitches from children (because oftheir crying and difficulty in staying still), absorbable materials shouldbe used when suturing their wounds.
Braided Sutures
Braided sutures are made up of several thin strands of the suture mate-rial twisted together. Braided sutures are easier to tie than nonbraidedsutures. However, braided sutures have little interstices in the suturematerial, which can be a place for bacteria to hide and grow, resultingin an increased risk of infection.
Nonbraided Sutures
Nonbraided sutures are simply a monofilament, a single strand. Theyare not made up of the little subunits found in a braided suture.Nonbraided sutures are recommended for most skin closures, espe-cially wounds that may be at risk for infection

INSTRUMENTS NEEDED:-
Needle holder: used to grab onto the suture needle
Forceps: used to hold the tissues gently and to grab the needle
Suture scissors: used to cut the stitch from the rest of the suture material.

Simple Sutures
Indication- This technique is the easiest to perform. It is used formost skin suturing.
1. Start from the outside of the skin, go through the epidermis intothe subcutaneous tissue from one side, then enter the subcuta-neous tissue on the opposite side, and come out the epidermisabove.
2. To evert the edges, the needle tip should enter at a 90° angle tothe skin. Then turn your wrist to get the needle through thetissues.
3. You can use simple sutures for a continuous or interrupted closure.

SUTURE REMOVAL:-

When?
Face: 3-4 days
Scalp: 5 days
Trunk: 7 days
Arm or leg: 7-10 days
Foot 10-14 days

How?
Many patients are very apprehensive about suture removal, so the first step is to reassure the patient that the procedure is not painful. The skin should be cleansed. Hydrogen peroxide is a good choice for gently removing dried blood and exudate.
Then grasp one of the “ears” of the suture with a forceps to elevate the suture just enough to slip the tip of a small scissor under the suture in order to cut it. This should be done close to the skin edge in order to minimize the amount of contaminated suture that will be dragged through the stitch path. The suture is then gently removed by pulling with the forceps. It is frequently a good idea to reinforce the wound with Proxi-Strips. These are narrow adhesive strips that are placed perpendicularly across the wound at intervals.