BACKGROUND
Subcuticular sutures are commonly used for surgical wound closure. We have found that knots and free ends can protrude through the skin, leading to minor wound infections. We have devised a simple, reliable technique to avoid these problems.
TECHNIQUE
Using a braided absorbable suture, the suture is passed percutaneously, entering the wound, via the dermis, a few millimetres from its apex. The first stitch takes a very small bite of dermis and is then locked (Fig. 1). If the suture slips, a second short locking stitch is inserted. The usual subcuticular technique is used to close the wound and a single, short, locking stitch is sufficient to secure the repair distally (Fig. 2). The suture is passed through the wound, exiting the skin distal to the apex and the ends are cut flush with the skin.
Figure 1.
Starting the suture.
Figure 2.
Completion of the suture.
DISCUSSION
This technique is quick and simple. It has the advantage of being entirely subcuticular and of avoiding bulky knots and free suture ends, which may protrude through the skin or lead to stitch abscesses. It also avoids piercing the suture material, thereby retaining suture strength. We have used this technique successfully for several years.