Simple Interrupted Suture
The simple interrupted stitch is a suturing technique used to close wounds. It is the most commonly used technique in the closure of skin. It is known as an interrupted stitch because the individual stitches aren’t connected; they are separate. Placing and tying each stitch individually is time-consuming, but this technique keeps the wound together even if one suture fails.
It is simple and relatively easy to place. A surgeon’s knot or knots cross the wound perpendicularly. The knots should not be left over the wound but placed to one side in order to avoid scarring and to make the removal of the stitches easier
Suture Material Choice
With all procedures, it is best to use the thinnest suture possible in order to minimize the risk of track marks and foreign-body reactions. Suture choice will depend mainly on anatomic location and the goal of suture placement. Simple interrupted sutures may be placed with the goal of (1) accomplishing epidermal approximation in a wound under moderate tension, such as a laceration or punch biopsy, or (2) fine-tuning the epidermal approximation of a wound where the tension has already been shifted deep utilizing a deeper dermal or fascia suturing technique.
On the face and eyelids, a 6-0 or 7-0 monofilament suture may be utilized for epidermal approximation. When the goal of simple interrupted suture placement is an entirely epidermal approximation, this suture material may be used on the extremities as well. Otherwise, 5-0 monofilament suture material can be used if there is minimal tension, and 4-0 monofilament suture may be used in areas under moderate tension where the goal of suture placement is relieving tension as well as an epidermal approximation. In select high-tension areas, 3-0 monofilament suture may be utilized as well, particularly in the context of a multimodality approach, for example when mattress sutures are placed in the center of the wound to maximize tension relief and eversion, and simple interrupted sutures are placed at the lateral edges of the wound to minimize dog-ear formation.
Procedure
- Start in the middle of the wound, place sutures at 1cm intervals until the wound is approximated without tension.
- For each suture, grasp and evert the skin edge (gently with the non-dominant hand).
- Pronate the dominant hand so that the needle will pierce perpendicular to the skin and drive the needle through the skin by supinating the hand before picking up the needle (2/3 from the tip) with the needle holders. A no-touch needle technique is important, reducing sharps injury and infection risk
- Finish by carefully gathering the thread to create a long thread (with a needle) and short thread, before performing a hand or instrument tie.
- Repeat with separate sutures to close the wound.