Subcuticular Running Suture

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our next stitch is a running
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subcuticular sutures
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h-how’d of all the sutures were teaching
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you this is probably the hardest to
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master this is probably for the most
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cosmetic closure as they’re running
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within the dermis deeply so there’s no
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sutures on the outside at all so you
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won’t see any of the railroad tracking
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that you would see from any other
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outside sutures this is a absorber and
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we will start by burying the knot so
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I’ll go deep in the corner away from the
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skin maybe just a very deepest part of
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the dermis and we’ll do our instrument
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tie and this allows the knot to be
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buried so we can suture over it this is
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important because we don’t want knots
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coming up to the skin they can stick out
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it’s called spinning patients do not
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like it when they’re not spit now with
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not as deep so we’re gonna go deep and
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we’re gonna come superficial and that
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brings us right up to the corner and
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this is where we’re gonna start our so
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particularly run when you start to get
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close to a corner definitely recommend
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smaller bites to start see I’m just
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within the dermis horizontal bites only
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to advance a little bit on the other
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side and take another small bite again
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stay well within the dermis
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now with this stitch Simoes asked us how
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much do you advance each time what I
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like to do is to see here with my suture
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where the next bite should be and that’s
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where I’m gonna put it so in some sense
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it depends on how much tension there is
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how this wounds there’s not a lot of
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tension now we’re gonna start to take
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regular bites on each side I’m trying to
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take the same depth and the same amount
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of tissue each time as we begin to
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advance
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keep pulling everything up and keeping
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tension
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notice I’m not pulling up very tight
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either just getting the skin to
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approximate no buttonholing of the skin
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this is just pure horizontal dermis
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wants to come right there
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gonna get a good play the dermis
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wants to come right there
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and just like when we started as you
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begin to approach the corner you want to
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stop taking such big bites and start
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going to some smaller bites because you
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really want these skin edges to be well
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approximated at the corner and not
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create any dog ears we also want to bury
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our knot so if we’re on a berry or not
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we have to start thinking about now
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about getting deep with both of the two
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ends that are gonna get tied so at this
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point here I’m superficial and I’m gonna
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go superficial on this side and then
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head deep that’ll get me down just sort
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of where we started down deep and I’m
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going to take one more bite that’s deep
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now I’m going to tie that and that’ll
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help to bury the knot
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and now what I’m gonna do to help bury
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the knot as well is to cut this short
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end here right on the edge of the knot
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and now take the needle and very that
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not further so I’m gonna pick up here
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and see where that knots going I can
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come out through the skin nearby and
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just simply pull up on this I can just
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cut it flush with the skin that helps
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the duck are not from our suture