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or PS) is often used for repairs on the face. A small needle (e.g., P3) should be
used for wounds that require fine cosmesis. Needles come in various sizes such as
3/8 and 1/2 circle. Clinicians may develop a preference for a specific needle.
However, in general, a 3/8 reverse cutting needle satisfies most needs.
Closure Techniques. Two of the most important goals of suturing are to match
the layers of the injured tissues and to create eversion of the wound margins so
they will flatten as the wound heals. Layers on one side of a wound should be
sutured to the corresponding, matching layers on the other side. First, all layers of
skin that have been injured should be identified. Then, an attempt to oppose each
layer (muscles, fascia, subcutaneous tissue, and skin) as nearly as possible back to
its original location should be made. This is achieved by carefully matching the
depth of the bite taken on each side of the wound when suturing.
Proper suture placement should result in slight eversion of the wound so there
is not a depressed scar when remodeling takes place. Eversion may be achieved
by slight thumb pressure on the wound edge as the needle is entering the opposite
side. Sutures should take equal bites from both wound edges so one margin does
not overlap the opposite margin when the knot is tied. Wound edge eversion is
best achieved by taking proper bites while suturing, not by pulling the knot tightly
( Fig. 110.2 ).
Suture placement may be deep or superficial. Deep sutures reapproximate the
dermal layers of skin and do not penetrate the epidermis. They help relieve skin
tension and improve the cosmetic appearance by reducing the width of the scar.
They should be avoided in wounds prone to infection because they will further
increase this risk. To place a deep suture, the needle is placed at the depth of the
wound and removed at a more superficial level. The needle is then inserted
superficially into the opposite side of the wound and exits deeply so the knot is
buried within the wound. The needle end and free end of the suture should be on
the same side of the loop before the knot is tied ( Fig. 110.3 ). The simple
interrupted technique (described next) with absorbable suture material should be
used.