Despite the growing use of surgical glue, sutures are still a primary method for sealing gashes—from superficial to serious.
A 2020 multicenter study found that over 26 million patients visited American emergency departments with at least one laceration. Around 9 million of those wounds were closed using sutures or staples.
This is an essential skill for today's medical professionals in hospital and clinic settings. Medical students—from those training to be nurses to paramedics—typically use kits to practice their technique. However, it's hard to know if your skills are improving without knowing what mistakes you could be making.
Read on to learn about the most common suturing errors beginners encounter.
1. Handling Equipment With Bare Hands
Sterilization is essential in almost every medical procedure.
Of course, tools, instruments, and supplies must be sterile. But the person practicing the procedure must ensure their hands are equally as clean.
This means never touching instruments (such as the suturing needle) or removing supplies from their packaging with your bare hands. Always wash your hands, don a new pair of gloves, wear a face mask, and keep your hair well away from your face and the surgical site.
Practicing these habits even during workshops and simulations is a good idea. This will set you up for success when working in a clinical setting with live patients.
It may take a while to master grasping forceps or recapping an anesthetic needle while wearing gloves. But be patient and persevere. This is a skill you will use your entire career.
2. Incorrect Forcep Technique
If you're using forceps, you must ensure your technique is sound or risk wound closure problems.
One of the most common errors learners encounter is not knowing how much grip to use on the forceps. This may mean using too many fingers to hold the forceps or gripping them too tightly. A tight or overcompensated grip can hinder your suturing ability.
Don't forget, too, to practice loading the needle into the forceps. For hygiene purposes, it's essential to learn to hold the needle correctly and stabilize the skin with forceps rather than your fingers.
3. Tissue-Related Problems
There are several tissue-related errors you can make while suturing a patient.
Layered repair is essential for closing dead space and relieving tension on the skin. This ensures a clean, attractive repair. To do this, the medical professional must be able to recognize the difference between the dermis and the subcutaneous tissue.
Be careful, too, not to pull the stitches too tightly. You sometimes risk permanent tissue damage. Too little tension, however, can cause poor healing and poses an increased infection risk.
4. Suturing Haphazardly
When it comes to the stitching technique itself, a few things can go wrong. Most are associated with uneven sutures.
Often, beginners drive the needle into the skin at the wrong angle. You want to aim for a minimum of 90 degrees, which ensures the edges of the wound stay upright—called wound eversion. This ensures the wound is adequately closed and will heal in a cosmetically appealing manner.
You also need to ensure your sutures are wider than they are deep. A too-wide suture once again risks inversion.
Finally, you want to ensure you re-enter the skin with the needle directly opposite the exit site. This avoids creating a rippled effect, which can hinder healing and look unattractive.
A suture kit is invaluable for mastering needle angle and creating neat, equal stitches.
5. Knotting Incorrectly
Square knots are an essential feature of strong sutures. They ensure the stitches stay securely in place without slipping, pulling uncomfortably, or coming undone completely.
Three things are essential to being able to create square knots:
- Ensure you cross your hand with every throw
- Space your stitches so they're perfectly parallel
- Bring the needle driver in front of, not behind, the suture
Once you've looped the surgical suture thread through the epithelium on either side of the wound, pull it tighter and make a square knot. Only then can you cut the ends. You also need to make a square knot when completing subcutaneous sutures.
If you're completing figure 8-style sutures, you can also consider using a surgeon's knot. Make the judgment call depending on the wound type.
If you're new to performing stitches, invest in a suture practice kit so that you can perfect your knotting technique.
6. Not Stressing the Importance of Wound Care
The stitches are in, and the wound is closed. Success!
However, you're not quite finished yet. There's the suture after-care consultation to take care of.
One of the biggest mistakes is not adequately educating the patient on how to care for their wound once they're back home. Good wound care is essential to avoid emergency department returns for infection or other more serious issues.
Some things to explain to the patient include:
- How much ointment to apply (if they've been prescribed cream)
- How often should they change their bandages
- What should they do if they experience itching, redness, pain, or an allergic reaction
Ensure they understand exactly when they need to return to remove the sutures. In the case of dissolving sutures, be sure the patient knows they do not need to return unless they have a problem with their wound.
Skilled Sutures: The Mark of a Professional
Sutures, done correctly, offer a way to quickly, cleanly, and safely close a serious wound.Â
However, the repercussions of inadequate or unprofessional suturing can sometimes be more damaging than the original injury. Patients can experience everything from infection to nerve damage.
Knowing how to avoid sutures mistakes ensures your practice helps rather than harms your patients.
Whether you're a seasoned medical professional or just starting out in medicine, we have products to help you reach new heights of success. Browse our suture kits, and medical books today.
