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How To Repair a Laceration With a Subcuticular Running Suture
Step by Step Description of Subcuticular Running Sutures
(See How To Cleanse, Irrigate, Debride, and Dress Wounds for step-by-step descriptions of wound preparation, anesthesia, and dressing; see Cleanse, anesthetize, irrigate, and debride the wound as necessary. Place a sterile fenestrated drape over the wound. Place additional drapes nearby as needed to provide a large enough sterile work area. Approximate the subcutaneous layer as necessary, using interrupted sutures (eg, buried How To Do Plastic Surgical Repair With Buried Deep Dermal Sutures ). Place a dermal or subcutaneous suture about 1 to 2 cm away from one end of the wound and secure it with a knot. Use the needle attached to the suture to place the subcuticular sutures. Place subcuticular sutures 1 to 2 mm deep to the skin surface. Take similar-sized and small bites horizontally, alternating between sides of the wound and on the same plane for the full length of the laceration. Place each successive bite about 1 to 2 mm behind the exit point from the opposite side of the wound so that when the wound is closed, the entrance and exit points on either side are not directly apposed. Pull the suture taut and tie a knot with a tail and a loop of suture about 1 to 2 cm from the end of the wound. If needed to precisely align the laceration’s edges, place a fine (eg, 6-0) running skin suture on the surface, in addition to the subcuticular suture. At one end of the laceration tie a simple suture with a knot but leave the needle and suture attached. Evert the skin edges along the length of the laceration if possible. Advance the needle, taking small bites at a 45-degree angle to the long axis of the laceration (perpendicular to the skin) for the complete length of the laceration. After the final bite, extend a loop of suture from the wound and use this loop as one end of the suture for the final tie. Place and secure a dermal or subcuticular suture at one end of the laceration with a knot. Place subcuticular sutures as described above from one end of the laceration to the other. Pull the sutures taut, then tie a knot with a tail and loop of suture. Bury this final knot by inserting the needle into deeper tissue and exit with the needle several millimeters from the edge of the wound. Pull on the end of the needle so the knot disappears into the wound. 