Subcuticular suture—is it a misnomer?

Subcuticular suture—is it a misnomer? Eur J Plast Surg (2010) 33:233 DOI 10.1007/s00238-010-0448-y LETTER TO THE EDITOR Syed A. Mashhadi & Charles Yuen Yung Loh Received: 21 April 2010 /Accepted: 3 May 2010 /Published online: 22 May 2010 Springer-Verlag 2010 Sir, pass through the dermis. In one paper, the author used the The subcutis or hypodermis refers to the layer of tissue lying terms intradermal and subcuticular sutures, interchangeably beneath the dermal layer. It is also where the top-most layer of [5]. This can be particularly confusing, especially for trainee subcutaneous fat lies. When referring to a subcuticular suture, surgeons and undergraduate medical students. judging by its name alone, one would expect the suture to lie The method of skin closure by subcuticular suturing is very under the skin i.e. in the subcutaneous fat. However, most of the popular amongst the surgeons, especially Plastic surgeons. It surgeons in reality place this suture in the deep layer of the dermis gives better scarring as compare to interrupted sutures Review of the literature tells us that the origins of the which may produce cross hatching [6]. Also subcuticular subcuticular suture cannot be attributed to a single surgeon sutures are usually absorbable which obviates the need of but rather a combined effort by generations of surgeons suture removal, unnecessary pain and inconvenience caused beginning with Halsted in 1887 [1]. Halsted described his to the patient. It is also cost effective as it prevents the need suturing technique of skin closure over the repaired hernia for an additional visit to the clinic for suture removal. cord by burying interrupted sutures of very fine silk. These As the technique evolves, we propose that terminology sutures were placed in the underside of the skin to include should be correctly used to avoid any confusion. The term, only its deeper layer which is not occupied by sebaceous “intradermal suture” is a more appropriate substitute for the follicles [1, 2]. Perhaps Halsted was proposing the “subcuticular suture” because the suture passes through the subcuticular closure of a wound in his description. Since dermis rather than being placed underneath in the subcutane- then, the technique has evolved. ous tissue. The term intradermal is not only anatomically The initial theory to close the wound with buried correct but is also self explanatory. subcuticular sutures was to reduce the rate of infection, [1] but later Davis, in 1919 advocated the role of the subcuticular suture more for aesthetic purposes and hence References popularized its use [3]. Further developments in the technique took place in early 1960s when Straith proposed 1. Fisher GT, Fisher JB, Stark RB (1980) Origin of the use of the introduction of an intradermal suture to reinforce, evert subcuticular sutures. Ann Plast Surg 4(2):144–148 and decrease wound dehiscence which subcuticular sutures 2. Halsted WS (1889) The radical cure of hernia. John Hopkins Hospital Bulletin No. 1, p 12 are unable to achieve [4]. 3. Davis JS (1919) Plastic surgery, principles and practice. P. Since then, different papers describe the technique of Blakiston, Philadelphia subcuticular sutures which in fact pass through the dermis 4. Straith RE, Lawson JM, Hipps JC (1961) The subcuticular suture. rather than the subcutis. So far we have not come across any Postgrad Med 164 5. Raj J, Davis IC, Leshin B (1994) Through the eye of the needle: paper which highlights the fact that subcuticular sutures in fact saving your running intradermal suture. J Am Acad Dermatol 30 (4):643–644 6. de Waard J, Trimbos B, Peters L (2006) Cosmetic results of lower S. A. Mashhadi (*) C. Y. Y. Loh midline abdominal incision: Donati stitches versus a continuous Great Ormond Street Hospital, intracutaneous suture in a randomized clinical trial. Acta Obstet London, UK Gynecol Scand 85(8):955–959 e-mail: smashhadi@hotmail.com http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Plastic Surgery Springer Journals

Subcuticular suture—is it a misnomer?

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Publisher
Springer-Verlag
Copyright
Copyright © 2010 by Springer-Verlag
Subject
Medicine & Public Health; Plastic Surgery
ISSN
0930-343X
eISSN
1435-0130
D.O.I.
10.1007/s00238-010-0448-y
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Abstract

Eur J Plast Surg (2010) 33:233 DOI 10.1007/s00238-010-0448-y LETTER TO THE EDITOR Syed A. Mashhadi & Charles Yuen Yung Loh Received: 21 April 2010 /Accepted: 3 May 2010 /Published online: 22 May 2010 Springer-Verlag 2010 Sir, pass through the dermis. In one paper, the author used the The subcutis or hypodermis refers to the layer of tissue lying terms intradermal and subcuticular sutures, interchangeably beneath the dermal layer. It is also where the top-most layer of [5]. This can be particularly confusing, especially for trainee subcutaneous fat lies. When referring to a subcuticular suture, surgeons and undergraduate medical students. judging by its name alone, one would expect the suture to lie The method of skin closure by subcuticular suturing is very under the skin i.e. in the subcutaneous fat. However, most of the popular amongst the surgeons, especially Plastic surgeons. It surgeons in reality place this suture in the deep layer of the dermis gives better scarring as compare to interrupted sutures Review of the literature tells us that the origins of the which may produce cross hatching [6]. Also subcuticular subcuticular suture cannot be attributed to a single surgeon sutures are usually absorbable which obviates the need of but rather a combined effort by generations of surgeons suture removal, unnecessary pain and inconvenience caused beginning with Halsted in 1887 [1]. Halsted described his to the patient. It is also cost effective as it prevents the need suturing technique of skin closure over the repaired hernia for an additional visit to the clinic for suture removal. cord by burying interrupted sutures of very fine silk. These As the technique evolves, we propose that terminology sutures were placed in the underside of the skin to include should be correctly used to avoid any confusion. The term, only its deeper layer which is not occupied by sebaceous “intradermal suture” is a more appropriate substitute for the follicles [1, 2]. Perhaps Halsted was proposing the “subcuticular suture” because the suture passes through the subcuticular closure of a wound in his description. Since dermis rather than being placed underneath in the subcutane- then, the technique has evolved. ous tissue. The term intradermal is not only anatomically The initial theory to close the wound with buried correct but is also self explanatory. subcuticular sutures was to reduce the rate of infection, [1] but later Davis, in 1919 advocated the role of the subcuticular suture more for aesthetic purposes and hence References popularized its use [3]. Further developments in the technique took place in early 1960s when Straith proposed 1. Fisher GT, Fisher JB, Stark RB (1980) Origin of the use of the introduction of an intradermal suture to reinforce, evert subcuticular sutures. Ann Plast Surg 4(2):144–148 and decrease wound dehiscence which subcuticular sutures 2. Halsted WS (1889) The radical cure of hernia. John Hopkins Hospital Bulletin No. 1, p 12 are unable to achieve [4]. 3. Davis JS (1919) Plastic surgery, principles and practice. P. Since then, different papers describe the technique of Blakiston, Philadelphia subcuticular sutures which in fact pass through the dermis 4. Straith RE, Lawson JM, Hipps JC (1961) The subcuticular suture. rather than the subcutis. So far we have not come across any Postgrad Med 164 5. Raj J, Davis IC, Leshin B (1994) Through the eye of the needle: paper which highlights the fact that subcuticular sutures in fact saving your running intradermal suture. J Am Acad Dermatol 30 (4):643–644 6. de Waard J, Trimbos B, Peters L (2006) Cosmetic results of lower S. A. Mashhadi (*) C. Y. Y. Loh midline abdominal incision: Donati stitches versus a continuous Great Ormond Street Hospital, intracutaneous suture in a randomized clinical trial. Acta Obstet London, UK Gynecol Scand 85(8):955–959 e-mail: smashhadi@hotmail.com

Journal

European Journal of Plastic SurgerySpringer Journals

Published: Aug 1, 2010

References

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