From the Guidelines
Yes, a subcutaneous (subcut) buried suture can be used for wound closure, as it reduces tension on the wound edges and promotes better healing, with a lower rate of superficial wound dehiscence compared to interrupted sutures, as shown in a Cochrane meta-analysis 1. This technique involves placing absorbable sutures beneath the skin surface to approximate the deeper layers of tissue. Common materials for buried sutures include absorbable options like Vicryl (polyglactin 910), PDS (polydioxanone), or Monocryl (poliglecaprone 25), typically in sizes 3-0 to 5-0 depending on the wound location and tissue thickness. To perform this technique, insert the needle into the subcutaneous tissue on one side of the wound, pass it through the deep dermal layer, and exit on the opposite side at the same depth. Tie the knot so it remains buried beneath the skin surface. This approach eliminates the need for suture removal, reduces scarring by minimizing tension on wound edges, and provides support during the critical healing phase. Some key points to consider when using buried sutures include:
- They are particularly useful for wounds under tension, deeper lacerations, or areas where cosmetic outcome is important.
- They should not be used in infected wounds.
- Proper wound cleaning and debridement should precede any suturing technique. Recent guidelines also suggest that antibiotic-coated sutures may be beneficial in reducing surgical site infections in emergency settings 1, but this does not directly relate to the use of buried sutures. Additionally, the choice between mass closure and layered closure techniques does not seem to affect the outcome in terms of incisional hernia or wound complications, with mass closure being preferred due to its faster execution 1.
From the Research
Subcuticular Suture Techniques
- Buried suture is a subcuticular suture technique that can be used for wound closure, as mentioned in the study 2.
- The study 2 also discusses other subcuticular suture techniques, including buried vertical mattress suture, intracutaneous butterfly suture, and modified/variant buried vertical mattress suture.
- A method for securing a subcuticular suture with minimal buried knot is described in the study 3, which can be useful for reducing bulkiness and gapping of the wound ends.
Buried Subcuticular Sutures
- The use of buried subcuticular sutures using catgut is described in the study 4, which found that catgut can be safely used for skin closure with gratifying results.
- The study 4 also notes that buried subcuticular sutures can provide excellent healing with fine linear scars, and that catgut has advantages over its synthetic counterparts, including easy availability, economy, and good handling.
Suture Materials for Subcuticular Skin Closure
- The study 5 compares the use of Vicryl and Monocryl for subcuticular skin closure at cesarean delivery, and finds that there is no significant difference in the risk of surgical site infection or other wound complications between the two materials.
- A systematic review and meta-analysis 6 compares the risk of surgical site infections and other wound complications associated with different suture materials for subcuticular skin closure at cesarean delivery, and finds that monofilament sutures are associated with a reduced risk of surgical site infections compared to multifilament sutures.
Application of Subcuticular Sutures
- The study 2 notes that patients can benefit from the appropriate application of subcuticular suture, and that fully understanding the history of subcuticular suture can help doctors improve their wound closure technique.
- The study 3 describes a technique for closing a skin wound under light to moderate tension with a retained subcuticular suture, which can be useful for surgeons.