Dr. Samer Makki Mohamed Al-Hakkak, the lecturer at the Faculty of Medicine, Publishes research titled "Modified Technique for Lengthy, Curved, Zigzag Running Subcuticular with Nonabsorbable Suture", in the American Journal "Journal of Surge
Journal of Surgery 2018; 6(1): 8-12 http://www.sciencepublishinggroup.com/j/js doi: 10.11648/j.js.20180601.12 ISSN: 2330-0914 (Print); ISSN: 2330-0930 (Online)
Samer Makki Mohamed Al-Hakkak
Department of Surgery, Faculty of Medicine, Jabir Ibn Hayyan Medical University, Najaf City, Iraq
To cite this article:
Samer Makki Mohamed Al-Hakkak. Modified Technique for Lengthy ,Curved, Zigzag Running Subcuticular with Nonabsorbable Suture. Journal of Surgery . Vol. 6, No.1, 2018, pp. 8-12. doi: 10.11648/j.js.20180601.12
Received : November 27, 2017; Accepted : December 8, 2017; Published : January 5, 20
Abstract: The use of non-absorbable sutures rather than embedded absorbable sutures in running subcuticular technique is preferable. The reasoning is that buried knot placement and embedded suture material under the skin increases the risk of granuloma formation, ugly scarring, and infection. Removal of the suture material reduces these risks. The new modified technique adopted for easily removed of non-absorbable monofilament using in long, curved and zigzag running subcuticular suturing by put interrupted rubber or plastic tube in the special technique that helps to get easily removed sutures with wonderful, scarless, best cosmetic suture line. Technical considerations go into placing these multiple pieces of tubes along the sutures line in an easy-to-remove manner.
Keywords: Lengthy Running Subcuticular Suture, Nonabsorbable Sutures, Removal, Suture Techniques.
A subcuticular suture refers to the more difficult technique of repairing a deep wound that extends below the top layer of skin, or epidermis. It is also called a sub dermal, or subcutaneous suture. For surgeons, suturing is considered an indispensable skill subcuticular suturing is a standard technique in dermatologic surgery. It is an ideal option for closing wounds that have minimal tension and mobility.  Suture marks are avoided by running the needle along the skin within the sub-epidermal plane.  Running subcuticular sutures are considered to be the “holy grail” of suturing techniques by many. That is to say, when done correctly, they give the best cosmetic outcome of closure. Because the epidermis is penetrated only at the start and end of the suture line, the subcuticular suture effectively eliminates the risk of suture marks. The characteristic feature of this technique is that the suture is placed intradermally. There is no visible evidence of the suture on the epidermal surface.  The benefit of running subcuticular suture is the minimal epidermal puncture points allowing the suture to be left in place longer without suture-track scarring. Sometimes, the suture cannot be easily removed, which can lead to a pulling force exceeding the tear strength of the wound. This can result in a ruptured thread that is trapped in the wound, for which several causes exist. It can happen when the thread is too large or varying in size or curved or zigzag. Another possible reason is that the stitches are not parallel to the wound edges or are lying too superficially in the epidermis. Especially in long wounds, this can lead to an immovable suture while being withdrawn in the manner described above.  So to prevent the suture ruptures, we use helpful techniques in removing it. Our favorite is to put into the middle of the wound or after about more than 5-10 cm distance of the beginning of running subcuticular put a bridge- like (piece of tube). A removal is necessary due to the risk of tissue reactivity, suture granuloma formation, and the possibility of the suture migrating through the epidermis. 
Using running subcuticular technique with nonabsorbable suture poses the potential risk of wound trauma during suture removal because of embedment. We present a simple modified technique that facilitates suture removal when approximating wound edges with a running subcuticular suture using nonabsorbable sutures. In summary, the combination of running subcuticular suture with a piece of tube demonstrates functional and cosmetic benefits that can be readily taught, comprehended, and employed, ultimately leading to desirable aesthetic results and successful wound without suture marking. It is recommended for all surgical skin sutures especially, long, curved and zigzag line. This technique can be used for easy removal of suture material from the wound without any disruption. This suture technique and removal inevitably reduces wound trauma from suture removal, especially in instances in which the running subcuticular may have been placed with overt backtracking. Obviously, a precise suture technique can prevent potential problems in removing the suture. In lengthy, curved, zigzag wounds which accomplished by running subcuticular suture should have bridges (a small piece of tubes) brought out parallel to the wound, facilitating suture removal. Obviously, a precise suture technique can prevent potential problems in removing the suture.
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