What is the best suturing technique for minor wounds?

Best Suturing Technique for Minor Wounds

For minor wounds, use continuous subcuticular sutures with slowly absorbable monofilament material (4-0 poliglecaprone or polyglactin), as this technique dramatically reduces wound dehiscence by 92% while requiring no suture removal and providing superior wound support. 1

Optimal Suture Technique

Continuous vs. Interrupted Suturing

• Continuous subcuticular suturing reduces superficial wound dehiscence dramatically (RR 0.08; 95% CI 0.02-0.35), meaning only 8% of the dehiscence risk compared to interrupted sutures 2, 1
• Continuous suturing is faster to perform, saving operative time while achieving equivalent or superior outcomes 2, 1
• No difference exists between continuous and interrupted techniques regarding surgical site infection rates (RR 0.73; 95% CI 0.40-1.33) 2
• The continuous technique creates a continuous seal along the wound edge that may better prevent bacterial invasion 1

Suture Material Selection

• Use slowly absorbable monofilament sutures (4-0 poliglecaprone or 4-0 polyglactin) as they retain 50-75% of tensile strength after 1 week, providing extended wound support 2, 1
• Monofilament sutures cause less bacterial seeding and reduce infection risk compared to multifilament materials 2
• Avoid rapidly absorbable sutures, as they increase incisional hernia rates and wound complications 2
• Slowly absorbable sutures may decrease postoperative pain compared to non-absorbable materials 2

Technical Execution

• Place sutures subcuticularly (beneath the skin surface) rather than transcutaneously to avoid nerve ending damage and reduce pain 2, 1
• Use non-locking continuous technique to distribute tension evenly across the suture line, preventing tissue edema and necrosis 2, 3
• Avoid pulling sutures too tightly, as this strangulates wound edges and causes tissue ischemia 2, 1
• For wounds requiring deeper closure, use layered technique starting with deeper tissues before closing the skin 2, 3

Critical Advantages of This Approach

Why Continuous Subcuticular Wins

• The dramatic reduction in dehiscence (from 22 of 23 cases in interrupted groups to nearly zero in continuous groups) stems from continuous wound support without requiring suture removal 1, 4
• Interrupted non-absorbable sutures require removal at 7-9 days, precisely when wound strength is still developing 2, 5
• Absorbable subcuticular sutures eliminate the need for painful suture removal visits 2, 1, 3
• The continuous technique provides mechanical support throughout the critical 1-2 week healing period 2

Common Pitfalls to Avoid

Material Selection Errors

• Never use rapidly absorbable sutures for wounds requiring structural support, as they lose tensile strength too quickly 2, 1
• Avoid catgut sutures entirely—they cause more pain and higher resuturing rates 2, 3
• Don't use multifilament sutures when monofilament is available, as multifilament increases bacterial seeding 2

Technical Mistakes

• Don't place interrupted transcutaneous sutures when continuous subcuticular technique is feasible—this increases dehiscence risk 12-fold 1, 4
• Avoid removing any sutures before 7 days, as premature removal causes wound breakdown 2, 5
• Never include adipose tissue or muscle in skin sutures—only approximate skin edges or use deeper layer closure first 2

Special Considerations

When to Modify Technique

• For high-tension wounds, ensure adequate deep layer closure before skin approximation to reduce surface tension 1
• In contaminated wounds, consider triclosan-coated antimicrobial sutures (OR 0.72 for SSI reduction; 95% CI 0.59-0.88) 1, 5
• For wounds in highly mobile areas (like lips), use layered closure with continuous non-locking technique to distribute tension 2, 3

Adjunctive Measures

• Adding adhesive steri-strips to continuous subcuticular closure provides no additional benefit and is not recommended 2
• Tissue adhesives alone carry 3.35 times higher dehiscence risk and should not replace sutures in structural closures 1

Evidence Quality Note

The recommendation for continuous subcuticular suturing comes from multiple high-quality guidelines including the 2023 World Society of Emergency Surgery guidelines 2, 2024 American Journal of Obstetrics and Gynecology guidelines 2, and 2020 World Journal of Emergency Surgery position papers 2. While some uncertainty remains due to study heterogeneity, the consistent direction of effect across multiple surgical specialties and the dramatic magnitude of dehiscence reduction (92% risk reduction) makes this the most evidence-based approach for minor wound closure 1, 4.