eMedicine Specialties > Dermatology > Surgical

Suturing Techniques: Multimedia

Author: Julian MacKay-Wiggan, MD, MS, Assistant Clinical Professor, Department of Dermatology, New York Presbyterian Hospital, Columbia University
Coauthor(s): Désirée Ratner, MD, Director of Dermatologic Surgery, Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center, New York Presbyterian Hospital
Contributor Information and Disclosures

Updated: May 1, 2009

Multimedia

Diagram of a needle.Media file 1: Diagram of a needle.
Diagram of a needle.

Diagram of a needle.

The needle is placed vertically and longitudinall...Media file 2: The needle is placed vertically and longitudinally perpendicular to the needle holder.
The needle is placed vertically and longitudinall...

The needle is placed vertically and longitudinally perpendicular to the needle holder.

The needle holder is held through the loops betwe...Media file 3: The needle holder is held through the loops between the thumb and the fourth finger, and the index finger rests on the fulcrum of the instrument.
The needle holder is held through the loops betwe...

The needle holder is held through the loops between the thumb and the fourth finger, and the index finger rests on the fulcrum of the instrument.

The needle holder is held in the palm, allowing g...Media file 4: The needle holder is held in the palm, allowing greater dexterity.
The needle holder is held in the palm, allowing g...

The needle holder is held in the palm, allowing greater dexterity.

Knot tying.Media file 5: Knot tying.
Knot tying.

Knot tying.

Simple interrupted suture placement. Bottom right...Media file 6: Simple interrupted suture placement. Bottom right image shows a flask-shaped stitch, which maximizes eversion.
Simple interrupted suture placement. Bottom right...

Simple interrupted suture placement. Bottom right image shows a flask-shaped stitch, which maximizes eversion.

Line of interrupted sutures.Media file 7: Line of interrupted sutures.
Line of interrupted sutures.

Line of interrupted sutures.

Running suture line.Media file 8: Running suture line.
Running suture line.

Running suture line.

Running locked suture.Media file 9: Running locked suture.
Running locked suture.

Running locked suture.

Vertical mattress suture.Media file 10: Vertical mattress suture.
Vertical mattress suture.

Vertical mattress suture.

Pulley stitch, type 1.Media file 11: Pulley stitch, type 1.
Pulley stitch, type 1.

Pulley stitch, type 1.

Far-near near-far pulley stitch.Media file 12: Far-near near-far pulley stitch.
Far-near near-far pulley stitch.

Far-near near-far pulley stitch.

Horizontal mattress suture.Media file 13: Horizontal mattress suture.
Horizontal mattress suture.

Horizontal mattress suture.

Tip stitch.Media file 14: Tip stitch.
Tip stitch.

Tip stitch.

Subcuticular stitch. The skin surface remains int...Media file 15: Subcuticular stitch. The skin surface remains intact along the length of the suture line.
Subcuticular stitch. The skin surface remains int...

Subcuticular stitch. The skin surface remains intact along the length of the suture line.

More on Suturing Techniques

References

References

  1. Adams B, Anwar J, Wrone DA, Alam M. Techniques for cutaneous sutured closures: variants and indications. Semin Cutan Med Surg. Dec 2003;22(4):306-16. [Medline].

  2. Ratner D, Nelson BR, Johnson TM. Basic suture materials and suturing techniques. Semin Dermatol. Mar 1994;13(1):20-6. [Medline].

  3. Richey ML, Roe SC. Assessment of knot security in continuous intradermal wound closures. J Surg Res. Feb 2005;123(2):284-8. [Medline].

  4. Adams B, Levy R, Rademaker AE, Goldberg LH, Alam M. Frequency of use of suturing and repair techniques preferred by dermatologic surgeons. Dermatol Surg. May 2006;32(5):682-9. [Medline].

  5. Alam M, Goldberg LH. Utility of fully buried horizontal mattress sutures. J Am Acad Dermatol. Jan 2004;50(1):73-6. [Medline].

  6. Wong NL. Review of continuous sutures in dermatologic surgery. J Dermatol Surg Oncol. Oct 1993;19(10):923-31. [Medline].

  7. Skaria AM. The buried running dermal subcutaneous suture technique with a tacking knot. Dermatol Surg. Aug 2002;28(8):739-41. [Medline].

  8. Nahas FX, Solia D, Ferreira LM, Novo NF. The use of tissue adhesive for skin closure in body contouring surgery. Aesthetic Plast Surg. May-Jun 2004;28(3):165-9. [Medline].

  9. Nitsch A, Pabyk A, Honig JF, Verheggen R, Merten HA. Cellular, histomorphologic, and clinical characteristics of a new octyl-2-cyanoacrylate skin adhesive. Aesthetic Plast Surg. Jan-Feb 2005;29(1):53-8. [Medline].

  10. van den Ende ED, Vriens PW, Allema JH, Breslau PJ. Adhesive bonds or percutaneous absorbable suture for closure of surgical wounds in children. Results of a prospective randomized trial. J Pediatr Surg. Aug 2004;39(8):1249-51. [Medline].

  11. Greenhill GA, O'Regan B. Incidence of hypertrophic and keloid scars after N-butyl 2-cyanoacrylate tissue adhesive had been used to close parotidectomy wounds: A prospective study of 100 consecutive patients. Br J Oral Maxillofac Surg. Feb 25 2009;[Medline].

  12. Tsui YK, Gogolewski S. Microporous biodegradable polyurethane membranes for tissue engineering. J Mater Sci Mater Med. Mar 20 2009;[Medline].

  13. Murtha AP, Kaplan AL, Paglia MJ, Mills BB, Feldstein ML, Ruff GL. Evaluation of a novel technique for wound closure using a barbed suture. Plast Reconstr Surg. May 2006;117(6):1769-80. [Medline].

  14. Brodland D, Pharis D. Flaps. In: Bolognia J, Jorizzo J, Rapini R, et al. Dermatology. Philadelphia, Pa: Mosby; 2003:2287-303.

  15. Fewkes JL. Antisepsis, anesthesia, hemostasis and suture placement. In: Arndt, Leboit, Robinson, Wintroub, eds. Cutaneous Medicine and Surgery. An integrated program in dermatology. Philadelphia, Pa: WB Saunders; 1996:128-38.

  16. Garrett A. Wound closure materials. In: Wheeland RG, ed. Cutaneous Surgery. Philadelphia, Pa: WB Saunders; 2008.

  17. Jallali N, Haji A, Watson CJ. A prospective randomized trial comparing 2-octyl cyanoacrylate to conventional suturing in closure of laparoscopic cholecystectomy incisions. J Laparoendosc Adv Surg Tech A. Aug 2004;14(4):209-11. [Medline].

  18. Leal-Khouri S, Lodha R, Nouri K. Suturing techniques. In: Nouri K, Leal-Khouri S, eds. Techniques in Dermatologic Surgery. Philadelphia, Pa: Mosby; 2003:71-3.

  19. Lober CW. Suturing techniques. In: Roenigk RK, Roenigk HH, eds. Dermatologic Surgery: Principles and Practice. New York, NY: Marcel Dekker; 2008.

  20. McGinness JL, Russell M. Surgical Pearl: a technique for placement of buried sutures. J Am Acad Dermatol. Jul 2006;55(1):123-4. [Medline].

  21. Odland PB, Murakami CS. Simple suturing techniques and knot tying. In: Wheeland RG, ed. Cutaneous Surgery. Philadelphia, Pa: WB Saunders; 2008.

  22. Olbricht S. Biopsy techniques and basic excisions. In: Bolognia J, Jorizzo J, Rapini R, et al, eds. Dermatology. Philadelphia, Pa: Mosby; 2003:2269-86.

  23. Stasko T. Advanced suturing techniques and layered closures. In: Wheeland RG, ed. Cutaneous Surgery. Philadelphia, Pa: WB Saunders; 2008.

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Further Reading

Keywords

suturing techniques, suture placement, knot tying, simple interrupted sutures, simple running sutures, running locked sutures, vertical mattress sutures, half-buried vertical mattress sutures, pulley sutures, far-near near-far modified vertical mattress sutures, horizontal mattress sutures, half-buried horizontal sutures, tip stitches, absorbable buried sutures, dermal-subdermal sutures, buried horizontal mattress sutures, running horizontal mattress sutures, running subcuticular sutures, running subcutaneous sutures, suture removal

Contributor Information and Disclosures

Author

Julian MacKay-Wiggan, MD, MS, Assistant Clinical Professor, Department of Dermatology, New York Presbyterian Hospital, Columbia University
Julian MacKay-Wiggan, MD, MS is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Désirée Ratner, MD, Director of Dermatologic Surgery, Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center, New York Presbyterian Hospital
Désirée Ratner, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, American Society for Dermatologic Surgery, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Shobana Sood, MD, Assistant Professor, Department of Dermatology, University of Pennsylvania Hospital
Shobana Sood, MD is a member of the following medical societies: American Academy of Dermatology and American Society for Dermatologic Surgery
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Mary Farley, MD, Dermatologic Surgeon/Mohs Surgeon, Anne Arundel Surgery Center
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

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