Here at SurgiReal, we believe perfect practice leads to the best outcomes for practitioners and their patients. Our RealSkills® series tackles fundamental clinical tasks to support medical instructors and their students as they build competence and confidence in these essential skills. Today’s skill: How to Close a Wound. Let’s get started!
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When it comes to surgery, the transition between the classroom and the clinic can be a daunting one. Anyone training future clinicians knows that confident care is built on practice, and only perfect practice can lead to the highest quality care. Closing a wound is a foundational step in a patient’s healing and, therefore, an essential skill in NP and PA programs today. Closing a wound takes a systematic approach to ensure the best outcome for the patient.
Understanding the Wound
Wounds are typically closed with sutures that dissolve over time or are surgically removed after the wound is healed. But before the first suture is thrown, the wound needs to be assessed: is it a clean surgical incision, a laceration, or a traumatic wound? How many layers of tissue are involved? Assessing the wound before picking up the needle leads to fewer complications like infection, scarring, reopening, or hemorrhage.
After understanding the wound, you’re ready to prepare the wound for closure. Control any bleeding, clean away any debris, treat infection, and make the patient comfortable with local or general anesthesia. Next, it’s time to employ one of three suturing techniques commonly used to close a wound. Let’s break them down!
Choosing the Technique
Interrupted Suture
An interrupted suture is a technique used to close wounds with precise, individual stitches. Every stitch is independently tied with a knot, so if one stitch fails, the others remain intact. It’s important to make sure there is equal tension across the stitches and to tie the suture off with a strong surgical knot. This versatile stitch is widely used across many types of wounds, so mastering this skill is essential.
Continuous Suture
A continuous suture involves placing a series of stitches without cutting and knotting the suture material between each stitch. This efficient technique is commonly used for long wounds and skin closures, especially when the wound needs to be closed quickly. But be careful not to close the wound too tightly as this can restrict blood flow.
Subcuticular Closure
A subcuticular closure is a technique used to close wounds by placing sutures just beneath the skin surface. This technique is commonly used for facial and cosmetic wounds because there is minimal scarring.
How to Throw a Suture
Now that the wound has been assessed and the proper technique selected, it’s time to throw the first stitch. NP and PA students should gather the following materials to help master this skill the right way the first time:
- Sutures (Absorbent or non-absorbent, depending on the wound)
- Needle holder
- Scissors
- Forceps
- Gloves
- 6 Layer Suture Pad
Hold the needle with the needle holder and insert it 1cm from the edge of the wound, pointing the needle toward the center of the wound. Then, pass the needle through the tissue (or suture pad) to the opposite side of the wound, leaving enough room in the suture to make a knot.
With the needle holder in one hand and the forceps in the other, cross the first end over the second (depending on handedness and the orientation of the wound), making an “X.” Then make a knot by tucking the first end under the second, making a loop, and pulling tight. For the second throw, cross the second end over the first end, then tuck the second end under the first and pull tight. The two ends should come out evenly, making a square, flat, and secure knot. Trim the excess suture material with your scissors.
- Still perfecting your surgical knot? Check out our SurgiSkill piece on knot tying for a deep dive into this essential skill.
Improving Technique
When it comes to closing a wound, confidence comes with consistent and perfected practice. Here are a few tips for your stitching practice:
- Angles matter. Make sure the needle points toward the wound at the right depth needed for the tissue layer.
- Hold each strand of the suture material with equal tension, especially when doing continuous sutures.
- Space your sutures evenly. Aim to pass the needle 1cm outside of the wound edge.
- Practice with a suture pad to build muscle memory and improve precision.
Here at SurgiReal, we created the RealSuture 6-Layer Suture Pad with surgeon educators so you can learn how to close a wound the right way the first time. Read on to learn how practicing with a suture pad can help you master foundational clinical skills.
Practicing with a Suture Pad
A suture pad is designed to mimic the first six layers of the abdominal wall: Epidermis, Dermis, Subcutaneous, first Fascia layer, Muscle, and second Fascia layer. Each layer of the RealSuture 6-Layer Suture Pad feels like a real tissue layer, so you’ll learn the skill of suturing the right way from the start. Resist the temptation to make your own suture pad from household materials; you want your training materials to simulate what you’ll find in the clinic. Also, not only will a suture pad come in handy when you practice various suture patterns, but you’ll also use it to practice knot-tying, burying sutures, and skin reconstruction. When you invest in high-quality, long-lasting training materials, you – and your patients – will reap the benefits in the long run.
When closing a wound, all of the steps hold equal value. Assessment, preparation, and technique come together to make sure a wound heals without complications. If you are a student preparing for your clinical exams or a seasoned clinician wanting to brush up on your skills, mastering the art of wound closure will contribute to better care for your patients. By using a 6-layer suture pad, you can practice on a product that feels like the real thing, so when the time comes to close a wound, you can walk with confidence from the classroom to the clinic.
Want to learn more about the art of knot tying? Check out this post.
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