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How To Do Plastic Surgical Repair With Buried Deep Dermal Sutures
Step by Step Description of Deep Dermal Sutures
(See How To Cleanse, Irrigate, Debride, and Dress Wounds for step-by-step descriptions of wound preparation, anesthesia, and dressing; see The goal is to invert each suture, which buries the knot beneath the plane of closure so that it will not interfere with epidermal healing. Cleanse, anesthetize, irrigate, and, if necessary, debride the wound. Place a sterile fenestrated drape over the wound. Place additional drapes nearby as needed to provide a large enough sterile work area. Insert the needle into the dermis at the bottom of the wound and direct it upward toward the skin surface, exiting near the dermal-epidermal junction on the same side. Insert the needle on the opposite side of the wound near the dermal-epidermal junction, directly across from the point of exit. Take small bites to avoid puckering of the skin surface. Exit the bite at the same dermal plane as and opposite the bite on the other side. Tie the knot, using 3 or fewer throws. Cut the suture, leaving about a 3-mm tail. If needed to help achieve precise skin approximation, suture the skin. Place a fine (eg, 6-0) running skin 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 suture for the final tie. The suture begins and ends at the bottom of the wound so that the knot is deeply buried. 