Simple running suture

Christoffer Bing Madsen, MD, Magnus Balslev Avnstorp MD, Specialist Plastic Surgery

Application

Used for epidermal approximation. Can be used both as a stand-alone but mostly as a second layer to aid after dermal/other deep sutures

Suture material choice

On the face/eyelids a thickness of 6-0 monofilament will most likely work. 6-0 monofilament can also be used on extremities as well. Otherwise 4.0 – 5.0 in case of moderate tension.

Step by step guide

1. The needle is inserted perpendicular to the epidermis
2. Rotate needle through dermis so the needle tip exits the skin on the contralateral side
3. Grasp needle body (not tip!) with forceps and pull upward
4. Release needle body from driver
5. Tie off gently and aim to minimize tension
6. Now start proximal from the prior knot you tied and repeat step 1-4
7. Instead of tying a knot, simply repeat steps 1-4 until the wound edge is reached
8. When the wound edge is reached load the needle with a backhand and insert in the skin with a perpendicular angle in a mirror image of the previous throws
9. The suture is only partly moved through the tissue, leaving a loop of suture!
10. Tie using an instrument tie with the help of the loop.