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Subject: Running Cutaneous Suture
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The basic skin-suturing instruments used are listed in Appendix G.
A suggested anesthesia tray that can be used for this procedure is listed in Appendix F.
Skin preparation recommendations appear in Appendix E.
Emergency triage situations that do not allow time for interrupted closure
Closure of long wounds in less cosmetically important (nonfacial) areas
Shallow wounds with loose skin nearby, such as the scrotum or dorsum of the hand
To secure a split- or full-thickness skin graft
Widely separated wound edges that are better approximated with tension-reducing sutures
Severe bleeding disorders
Extreme illness that would make wound healing difficult
Cellulitis in the tissues to be incised
Conditions that may interfere with wound healing (collagen vascular diseases, smoking, renal insufficiency, diabetes mellitus, nutritional status, obesity, chemotherapeutic agents, and corticosteroids)
Disorders of collagen synthesis that affect wound healing such as Ehlers-Danlos syndrome and Marfan syndrome
Concurrent medications that may increase the likelihood of intraoperative bleeding (aspirin, other nonsteroidal anti-inflammatory drugs, warfarin)
Patients with a propensity to pick at wounds or sutures
PITFALL: Many providers immediately start making diagonal passes across the top of the incision at this point, but this allows the knot to migrate across the incision, loosening the sutures.
Pearl: Make sure the sutures are evenly spaced and the tension is distributed along the suture line.
PITFALL: Do not tie the suture too tightly. The wound edges will bunch up if the final knot is too tight.
Crosshatch scarring, especially when the suture is pulled too tightly
Uneven wound edges
Puckering of the wound
Wound dehiscence if the suture thread breaks