Stitches and Staples
Definition
Stitches and staples are two methods by which a wound may be closed. Stitches use specialized needles and thread to "sew" a wound closed. Staples are thin pieces of metal that are placed with a stapling device through the edges of a wound to hold it closed.
Description
Wounds to the skin, fat, muscle, blood vessels, and other structures in the body may occur accidentally (as in a cut) or purposefully (as in a surgical incision). A number
Stitches
Sutures, as stitches are often called, are the way that most wounds are closed. Suture materials have various characteristics that determine their use. The two main components of suture materials are the needle and thread.
MATERIALS. Suture thread is often characterized by how long it retains its strength in tissue. Absorbable stitches lose their strength in a matter of days or weeks and are eventually absorbed by the tissue. This characteristic is useful for the suturing of subcutaneous tissues. Nonabsorbable stitches retain their strength for months to years and may never be absorbed by the tissue. They are generally used for skin and removed once the wound has sufficiently healed. Suture thread is made of various natural or synthetic components and comes in different diameters for use in different types of tissues. Very fine suture threads are used to close cuts on the face, while threads with a larger diameter are required for subcutaneous tissues.
Suture needles may resemble a conventional sewing needle with an eye through which suture material is threaded, or they come with suture thread attached at one end; this connection is called a swage. Needles may be straight or curved; the most commonly used shape is the semicircle, which permits easier manipulation through tissues by the clinician. Needles vary in length from less than 0.1 in (2 mm) to 2.4 in (60 mm). The point of a needle may be cutting (for such tougher tissues as the skin), rounded (for such easily penetrable tissues as the subcutaneous layers), or blunt (for such easily damaged tissues as the liver).
TECHNIQUE. While various stitching techniques may be used depending on the location of the wound and type of tissue to be sutured, basic suturing technique remains the same. Several instruments are necessary for proper wound closure, including dissecting scissors (for cleaning the wound); suture scissors (for cutting suture thread); a needle holder (for manipulating the needle); and forceps (for manipulating tissue). Wounds resulting from an injury must be cleaned before closure; dead tissue and foreign bodies are removed and the area is cleansed with an antiseptic. Sutures may be interrupted (each stitch is separately placed, tied, and cut) or continuous (one continuous piece of thread composes all the stitches); they may be placed at different angles and depths.
Nonabsorbable stitches should be removed several days to weeks after their placement, depending on their location. For instance, sutures on the face should be removed in approximately 5 days; sutures on the legs and abdomen, in 7 to 10 days; and sutures on the back, in 10 to 14 days. Strips of adhesive tape may be placed over the wound to help support the tissue while it is healing.
