In a previously published Practical Pointer (CONSULTANT, August 2005), D. Brady Pregerson, MD, of Los Angeles proposed a method for tightening loose stitches after the clinician has finished suturing.
Editor's note: In a previously published Practical Pointer (CONSULTANT, August 2005), D. Brady Pregerson, MD, of Los Angeles proposed a method for tightening loose stitches after the clinician has finished suturing. He recommended running a loop between the first and last stitch on top of the skin, then cinching up both ends and tying off. We received the following comments on Dr Pregerson's suggestion from Charles Cusumano, PA-C:
Dr Pregerson responded to Mr Cusumano as follows:
We posed this question to Murad Alam, MD, assistant professor of dermatology and otolaryngology and chief of cutaneous and aesthetic surgery at Northwestern University's Feingold School of Medicine in Chicago. His response follows.
The main problem with running locked sutures is that if they are cinched very tight, visible "track marks" from the superficial suture may be unavoidable and persistent. On the face, such marks may be cosmetically unacceptable. Thus, although closure with running locked sutures may be acceptable on the scalp, on the face other methods of limiting bleeding-such as electrocoagulation with portable hyfrecation-are usually preferable.
If the problem is not bleeding but a running suture that is too loose, a simple interrupted suture can be placed in the area of looseness. Alternatively, the entire suture can be removed, and a deep, absorbable suture can then be placed before application of new superficial running sutures. Even a single deep suture can bring the wound edges close enough together to reduce tension and, as a result, reduce the loosening of the top running suture.
Editor's note: For an in-depth, illustrated treatment of suturing techniques, see our new feature, "Primary Care Procedures: A Photo Guide,".