The Origin and Development of Interrupted Subcuticular Suture: An Important Technique for Achieving Optimum Wound Closure

Abstract

Background: Subcuticular suture is an important technique for achieving optimum wound closure, and there has been no comprehensive summary of subcuticular sutures to date.

Objective: To summarize the origin and development of interrupted subcuticular suture to help clinicians improve their wound closure skills.

Materials and methods: A comprehensive review of subcuticular suture techniques was conducted in PubMed to summarize the advantages and disadvantages of various methods and clinical indications.

Results: Buried suture is the oldest subcuticular suture technique, followed by buried vertical mattress suture, intracutaneous butterfly suture, modified/variant buried vertical mattress suture, intradermal buried vertical mattress suture, buried horizontal mattress suture, wedge-section and modified buried vertical mattress suture, set-back suture, and modified buried horizontal mattress suture, which have gradually been applied in clinical practice. Buried vertical mattress suture is currently the most widely used subcuticular suture technique.

Conclusion: Patients can certainly benefit from the appropriate application of subcuticular suture. There is also no single ideal method for achieving optimal results in all cases. Fully understanding the history of subcuticular suture can help doctors improve their wound closure technique.

Figure 1.

Comparison of everted and plane sutures. (A) Suture path of Halsted's buried sutures; (B) side view after buried suture with a planar wound; (C) suture path of buried vertical sutures; (D) ridge-like side view after buried vertical suture with wound edge eversion.

Figure 2.

Intradermal butterfly suture. (A) Suture path of a single intradermal butterfly suture; (B) view from above, with the suture arcs as the wings and the knot as the head of a butterfly; (C) suture path of a double butterfly suture; (D) the 2 mirrored “S,” view from above.

Figure 3.

Suture path of developed subcuticular suture techniques. (A) Modified buried vertical mattress suture; (B) intradermal buried vertical mattress suture; (C) buried horizontal mattress suture; (D) WE-MBVMS; (E) set-back suture; (F) modified buried horizontal mattress suture. WE-MBVMS, wedge-shaped excision and modified buried vertical mattress suture.