Intended for healthcare professionals

Student Education

Basic plastic surgery techniques and principles: How to suture

BMJ 2003; 326 doi: (Published 01 June 2003) Cite this as: BMJ 2003;326:0306182
  1. Ben Taylor, third year medical student1,
  2. Ardeshir Bayat, specialist registrar in plastic surgery1
  1. 1University of Manchester

In the second article of our series, Ben Taylor and Ardeshir Bayat explain suture techniques, how to prepare a wound, and how to get the best possible scar

Stitching (suturing) a wound is a surgical skill which also has widespread applications outside the field of surgery. We are all likely to be called on to suture a wound at some point in our training. Few students have enough confidence, however, to deal with wounds, and it can be hard to learn. In this article we look at the basics of wound healing suturing technique. We discuss a few more advanced techniques and share the secrets of getting best possible results.


Wound healing

To understand the basis of suturing, it is important to know how wounded skin heals. This occurs in four phases (although there is some overlap).

Haemostasis--Immediately after wounding, a platelet plug forms and blood vessels vasoconstrict. Later, a thrombus develops to seal the wound.

Inflammation--This occurs in the first two to three days after the injury, causing swelling of the wound edges. White blood cells remove necrotic tissue, and control infection.1

Proliferation--Beginning on the second or third day after the injury, and lasting for two to four weeks, structure forming cells called fibroblasts proliferate into the wound, and produce structural proteins such as glycosaminoglycans, collagen, and elastin.2 New capillaries form at this time, and epithelial cells migrate across the top of the wound. Areas where this is occurring are known as “granulation tissue.”

Remodelling--After the proliferative phase subsides, the new capillaries atrophy and collagen changes from type III to type I and is rearranged so that it gives the best tensile strength. Myofibroblasts cause scar contracture. Strength of the wound increases to almost 80% of the original strength over this period of …

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