(p) Pull the knot to the side so that the knot will not lie directly over the
(q) Repeat the pattern of looping the suture around the holder on
alternate sides of the wound. Do this until the desired number of throws have been
Cut the ends of the suture material approximately three to five
d. Single Layer Closure. The single layer closure of a wound is the technique
of choice for repairing most of the lacerations that are treated in an emergency
department. Most lacerations of the extremities, trunk, and scalp require only one layer
of suturing. Single layer closure is usually not used on the face. Before starting to
repair the wound, decide how far the sutures should be placed from each other and how
far they should be from the edge of the wound. When there are definite landmarks
(eyebrows, lip, etc.), place the sutures so that the landmark is brought into alignment.
Use one of these two methods of suturing:
One method. Start at one end of the wound and work to the other end of
Another method. Continually bisect the wound until the wound is closed.
The second technique listed can cause the tissue to buckle. This is
referred to as "dog-eared."
ADVANCED SUTURING TECHNIQUES
a. Running Suture. A running suture is similar to the simple suture in
technique. The difference is that the suturing material is not cut and tied with each
succeeding stitch. Multiple loops are made, starting at one end of the laceration and
working toward the other end of the laceration. For the final loop, enter the skin just
beside the entry point of the preceding stitch. After all the loops are in place, adjust the
tension along the repair and tie the suture to itself.
(1) Advantages. Among the advantages of the running suture are that
these sutures are inserted fast and are easy to remove. Also, the cosmetic appearance
is comparable to that of interrupted sutures.
(2) Disadvantages. One of the disadvantages to the running suture is that a
break anywhere along the suture can cause the entire suture line to unravel. Also, if a
mistake is made, the suture must be cut, the loop removed, and the previous suture
stitch must be knotted.