Surgery: Suturing Techniques

Subcuticular Suture

  • Continuous suture which spreads wound tension
  • No marks on skin surface as suture is placed within the superficial dermis
  • Requires little wound tension therefore deep dermal sutures are essential
  • Knots can be tied at the start and the end of the suture or can be left without knots- the purpose of this suture is to oppose the wound edges, not to provide support as these wounds should be under minimal tension
  • Needle is inserted approximately 1cm from one end of the wound and the needle brought out within the superficial dermis at the apex of the wound
  • A knot can be tied at this point within the wound/outside the wound, or the suture can be continued as below and any knots placed at the end
  • Needle is then inserted into the dermis on one side of the wound at the same level and brought out at the same level further along the wound i.e. a horizontal bite of the dermis
  • Needle is then inserted into the superficial dermis at the same level on the opposite side at the same point in the wound as the emergence point from the previous bite and brought out at the same level (again taking a horizontal bite of dermis)
  • This should be repeated the full length of the wound, taking even horizontal bites
    At the end of the wound the needle should be inserted into the superficial dermis at the apex and brought out approximately 1cm from the wound edge
  • The suture will look like a ladder across the wound with no emergence through the skin except at the start and end
  • Knots can be tied at each end (tie the suture to itself) or the ends left exposed and secured with steri-strips
  • Skin glue or steri-strips can be used on top of the wound for further wound protection
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