What is the optimal spacing for deep dermal sutures?

Deep Dermal Suture Spacing

Deep dermal sutures should be placed approximately 5-10 mm apart, with 10 mm spacing generally preferred for optimal cosmetic outcomes and reduced tissue trauma.

Optimal Spacing Considerations

The spacing of deep dermal sutures is an important technical consideration in wound closure that affects both functional and aesthetic outcomes. While there is limited direct guidance specifically on deep dermal suture spacing in major dermatologic surgery guidelines, evidence from clinical practice and research provides valuable insights:

• Research shows that low-density suture spacing (approximately 10 mm apart) produces equivalent or better cosmetic outcomes compared to high-density spacing (approximately 5 mm apart) 1
• Placing sutures farther apart (10 mm) results in:
  • Fewer total puncture wounds
  • Decreased tissue trauma
  • Reduced surgical time
  • Conservation of suture material
  • Equivalent functional outcomes

Anatomical Considerations

The depth of dermal sutures should be determined by:

• Anatomical location of the wound
• Thickness of the dermis in the area
• Amount of tension on the wound edges

In most cases, deep dermal sutures should:

• Be placed in the deep dermis, just above the subcutaneous fat
• Provide adequate eversion of wound edges
• Distribute tension evenly across the wound

Technical Approach

When placing deep dermal sutures:

1. Use absorbable suture material (commonly 4-0 or 5-0 polydioxanone) 2
2. Place sutures in the deep dermis, approximately 5-10 mm apart
3. Ensure adequate eversion of wound edges
4. Avoid excessive tension that could cause tissue ischemia
5. Consider the specific anatomical location and wound characteristics

Special Considerations

• High-tension areas: May require closer spacing (5 mm) to distribute tension more evenly
• Facial wounds: Often benefit from precise approximation, but evidence suggests that single-layer closure without deep dermal sutures may be adequate for nongaping facial lacerations less than 3 cm 3
• Low-tension areas: Can often use wider spacing (10 mm) with excellent results

Common Pitfalls to Avoid

• Placing sutures too close together, which increases tissue trauma and doesn't improve outcomes
• Excessive tension on sutures, leading to tissue ischemia and poor healing
• Inadequate depth of placement, reducing the suture's ability to support wound closure
• Strangulation of tissue when tying sutures

By following these guidelines for deep dermal suture spacing, clinicians can achieve optimal functional and cosmetic outcomes while minimizing tissue trauma and operative time.