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Syed Abuzar Mashhadi, Charles Yuen Yung Loh, A Knotless Method of Securing the Subcuticular Suture, Aesthetic Surgery Journal, Volume 31, Issue 5, July 2011, Pages 594–595, https://doi.org/10.1177/1090820X11411080
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The subcuticular suture is one of the most commonly employed techniques for closure of wounds. It is particularly important in the realm of plastic surgery, as the results are usually aesthetically acceptable. In a recent publication, we proposed that the “subarticular” terminology is a misnomer, and this technique should be described as intradermal instead.1 For this reason, we will employ that terminology in this letter.
There are three primary types of wound closure: suturing, skin clips, and tissue adhesives. Each technique has its own advantages and disadvantages. For example, tissue adhesives have the advantage of being quick and easy to apply, but they are relatively expensive compared to other methods of wound closure.2 Skin staples are also fast and easy to place, but they can be painful to remove and are also more expensive than sutures.3,4
Suture closures can also be divided into two further categories: interrupted and intradermal. In intradermal wound closure, suture threads are embedded intradermally within the wound. This potentially avoids the crosshatching associated with interrupted suture technique, hence making intradermal wound closure cosmetically appealing. Intradermal sutures can be knotless, knotted, or placed with barbed wire suture. Knots can be placed either externally or internally. The advantage of tying knots is that the intradermal suture is secured firmly, and the chance of wound dehiscence is minimal. The disadvantage, however, is that these knots can be potential breeding grounds for bacteria, which may then predispose the wound to an increased risk of infection and stitch abscesses. Knots may also cause localized irritation and granulation, which may impair wound healing. Polydioxone sulfate (PDS) sutures are especially prone to erosion of knots through the skin, up to roughly 17% in one study.5
