Node technology
After each skin suture, the threads must be knotted. To achieve an optimal strength of the knot, three knots are always made, whereby these should be in opposite directions. Basically, the first knot should fix the wound in the intended position, while the second counter-rotating knot should stabilize the first knot.
To be on the safe side, a third knot is made. A prerequisite for a well-fitting knot is the tensile strength of the knot. Thin and smooth (monofilament) threads often require more knots to prevent the knot from opening by itself.
A knot should always be close to the wound, but not too tight to avoid constriction. For skin sutures, the knot is achieved directly with needle and thread by wrapping the end of the thread around it. Also here the looping should be done alternately clockwise and anticlockwise, three times in total.
Deeper knots are fixed by the index or middle finger knot. The special thing about this kind of knots is that they can be tied with only one hand. If the knots were tied with both hands, as in the case of tying shoes, the surgeon would have to have both hands available for this purpose and keep both threads under constant tension in order to firmly adapt the wound edges. The one-handed technique makes it possible to keep only one thread under tension while the other thread is knotted around the taut thread. This allows better control of the knot, its placement and tension.
Sewing technique
Thanks to the good development of suture material and suture and knotting techniques, most injuries today can be closed well and leave hardly any scars. Good wound care and cleaning before closing the wound edges is essential. In addition, suture material and suturing technique should be chosen carefully to avoid complications as far as possible.
Thanks to the large selection of different sutures, needles and suturing techniques, the optimum treatment can be found for almost every wound. In addition, it is also possible nowadays not only to suture wounds, but to close them with the help of clamps, adhesives or adhesive strips. However, it has been shown that scar healing is very individual and scar proliferation can hardly be avoided.
Nowadays, however, it is possible to make them cosmetically beautiful with the help of plastic surgery. Infections, increased resilience and mechanical stress should be avoided in any case, and infections should be treated as early as possible to avoid complications. In principle, every scar is still active about 1 year after the injury. Only after the past year is the final scar condition visible, and only then should the scar, if necessary, be embellished by plastic surgery.
