Simple Running Suture Technique. How to master it.

Indications, step-by-step procedures, common errors, and training with suture pad

Introduction

As a medical student or surgical resident, developing suturing proficiency is crucial. Simple running suture is a fundamental technique used for wound closure, and mastering it will pave the way for more advanced suturing skills. This blog post guides you through the steps, applications, and potential pitfalls of the simple running suture while highlighting the benefits of practicing on a suture pad

What is a Simple Running Suture?

The simple running suture, also known as a continuous suture, involves placing multiple stitches through the wound edges with a single length of suture material. Each stitch “locks” into the previous one, creating a continuous closure. This technique offers several advantages, including speed and efficiency, particularly for longer wounds.

Simple Running Suture on UpSurgeOn SkinPad, suture training pad
Simple Running Suture on UpSurgeOn SkinPad, suturing pad

Simple Interrupted Suture Step-by-Step

Here’s a step-by-step breakdown of the simple interrupted suture technique:

STEP 1: Preparation

 Gather your materials: 

  • Needle holder
  • Suture scissors
  • Forceps
  • Suture material (appropriate size and type for the wound)
  • Suturing Pad

It is better to master the simple interrupted suture technique before further proceeding.

STEP 2: Securing the proximal end of the suture

Practice done with UpSurgeOn SkinPad
  1. Grasp the needle holder with your dominant hand and clamp the needle firmly at about two-thirds of its length. Use the nondominant hand to take the forceps and elevate the far side of the wound, close to the intended location for the first stitch. Insert the needle perpendicularly through one side of the wound edge, approximately 1cm away from the edge (a good rule of thumb is about half of the needle length, pushing it according to the needle curvature, ensuring that it passes through all tissue layers).  Grasp the opposite tissue edge with forceps and pass the needle through the opposite wound edge at a corresponding point, maintaining the same distance and perpendicular angle.
  2. Create a square knot. Hold one suture end with the needle holder and the other with the needle driver. Wrap the free end around the held end, forming a loop. Tighten the loop gently in a clockwise direction. Repeat the wrapping and tightening steps to create a second loop in an anticlockwise direction around the first. Then, proceed with a third loop in a clockwise direction. Pull both ends firmly to secure the knot.
Practice done with UpSurgeOn SkinPad

3. Cut only one of the suture ends close to the knot, leaving a short tail.

Practice done with UpSurgeOn SkinPad

STEP 3

Grasp the needle with the needle holder in the dominant heand and insert it again perpendicular to the epidermis, approximately one-half the radius of the needle distant to the wound edge. With a fluid motion of the wrist, rotate the needle through the dermis and exit the needle on the skin simmetrically on the contralateral side.

STEP 4

Repeat: Continue placing stiches, each one incorporating the previous suture loop, until you reach the opposite wound edge.

BE CAREFUL Equal needle bites of depth and distance from the wound should be taken to allow wound edges to oppose equally and neatly.

When to Use the Simple Running Suture:

This technique is suitable for closing:

  • Straight, clean wounds with minimal tension.
  • Lacerations on the face or other cosmetically sensitive areas where minimal scarring is desired.
  • Skin flaps requiring approximation.

Common Errors to Avoid:

  • Incorrect needle angulation: Ensure the needle enters and exits perpendicular to the wound edge.
  • Uneven bites and throws: Maintain consistent size and avoid excessive tension.

Practice done with UpSurgeOn SkinPad

  • Tying sutures too tightly: This can cause tissue ischemia and necrosis.
  • Leaving gaps between stitches: Ensure complete wound closure without bunching tissues.

Additional Tips and Tricks:

  • Needle handling: Practice smooth, controlled needle movements on gauze pads before moving to the SkinPad. Avoid jerky motions.
  • Tension control: Maintain slight tension on the suture without strangulating the tissue. Imagine a “wave” forming as the suture goes through the skin.

Practice done with UpSurgeOn SkinPad

  • Knot tying: Master both square and surgeon’s knots, ensuring tight, secure knots without excessive pulling.
  • Wound eversion: Slightly evert the wound edges with forceps for better cosmetic outcomes.
  • Suture removal: Use sterile technique and cut close to the knot and of every stitch to remove the suture and  minimize discomfort while ensuring safety, avoiding to pass all the suture material through the wound by only cutting near the distal or proximal knot.

Conclusion How to become a master with UpSurgeOn SkinPad

Mastering the simple running suture technique is a crucial skill for medical professionals involved in wound closure and surgical procedures. Understanding its indications, recognizing common errors, and practicing on hyper realistic suture pads are essential steps in becoming proficient in this technique. With dedicated practice and a commitment to continuous improvement, aspiring surgeons, nurses and medical students can develop the skills necessary to perform sutures with precision and confidence, ultimately contributing to positive patient outcomes and optimal wound healing. Here’s a few additional tips on how to master what you have just learnt.

  • Repetitive practice: Exercise every day
  • Record Progress: Record your progress and practice sessions to track improvements and identify areas for further development. 
  • Seek Feedback: If possible, when practicing ask for the guidance of experienced practitioners who can provide feedback and tips for improvement.

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Simple Running Suture Technique. How to master it.