Surgical sutures are essential for wound closure, bringing together tissue edges after an incision or injury. Many suturing techniques exist, each suited for particular wound characteristics. This article explores the continuous subcuticular suture, detailing its unique properties and placement.
What is a Continuous Subcuticular Suture
A continuous subcuticular suture is a specialized surgical stitch designed to close a wound by placing the suture material just beneath the outer layer of the skin, within the dermis. Unlike individual stitches that are tied off separately, this technique involves a single, unbroken strand of suture material that runs continuously along the length of the incision. This continuous nature means there are no visible knots on the skin’s surface, contributing to a smoother appearance.
The term “subcuticular” indicates that the suture is positioned in the dermal layer, which is the strong, fibrous tissue directly under the epidermis. Often, absorbable suture materials like polydioxanone (PDS) or poliglecaprone 25 (Monocryl) are chosen for this technique, which the body gradually breaks down, eliminating the need for removal.
The Technique of Placement
Applying a continuous subcuticular suture involves a precise method to ensure the stitch remains hidden and effective. The process begins at one end of the wound, with the needle inserted just beneath the skin’s surface at the incision margin. The needle is passed horizontally through the dermis, maintaining a trajectory parallel to the skin surface.
The needle then emerges at the same depth on the opposite side of the wound. This creates a “zigzag” or “S-shaped” pattern of stitches that are entirely internal. The surgeon continues this back-and-forth motion along the entire length of the incision, pulling the suture taut after each pass to bring the wound edges together. This achieves uniform spacing and consistent tension, ensuring the skin edges are well-approximated without creating puckering.
Primary Benefits of This Suture
The continuous subcuticular suture offers several advantages. One of the most significant benefits is the improved aesthetic result. Because the stitches are placed internally within the dermis and do not emerge through the epidermis, there are no visible stitch marks or “railroad track” scars. This technique helps to minimize tension on the skin’s surface, leading to a finer, less noticeable scar as the wound heals.
Another advantage, especially when absorbable suture materials are used, is the elimination of suture removal appointments. The body naturally dissolves these materials over time, which can range from several weeks to a few months depending on the specific type of suture. This reduces patient discomfort and saves time for both patients and healthcare providers.
The buried nature of the subcuticular suture contributes to a reduced risk of infection. With fewer external points of entry for bacteria, the wound is less exposed to contaminants. Studies have indicated that subcuticular sutures may allow greater blood flow to cutaneous wounds, which can promote healing and reduce the incidence of wound infection compared to staples. The continuous nature of the stitch also helps to distribute tension evenly along the wound edges, supporting optimal healing and minimizing complications like superficial wound dehiscence.
Aftercare and Recovery
Proper aftercare is important for optimal healing. Patients are advised to keep the wound clean and dry, particularly for the first 24 to 48 hours. While the internal sutures dissolve on their own, external wound closure strips or surgical glue may be applied to the outermost skin layer for additional support. These external aids fall off on their own within one to two weeks.
Patients should be vigilant for any signs of infection, such as increased pain, redness, swelling, unusual warmth, or pus-like discharge from the wound site. A fever within 48 hours of suturing can also indicate an infection. If any of these symptoms appear, it is important to seek medical attention. Avoiding activities that put excessive strain on the sutured area is recommended to prevent the wound from reopening. While the internal sutures will dissolve over 10-14 weeks, the incision site might appear slightly lumpy or bumpy during this period before flattening into a thin line scar.