Running percutaneous sutures allow for rapid closure of long lacerations. This technique distributes tension more equally across the wound compared with simple interrupted sutures.
Indications
Lengthy, linear lacerations that are not in cosmetically sensitive areas
Contraindications
Non-linear wounds
Technique Description
Start at one end of the wound. Throw the needle from far to near side and tie knots as you would for a simple interrupted stitch.
Then cut the shorter, free tail of the suture, but leave the suture on the needle-end attached.
Enter with the needle again on the far side of the wound and take repeated bites, spaced approximately one centimeter apart down the length of the wound.
On the last throw, leave slack in the suture on the far side of the wound to create a loop.
This loop is then used with the needle-end of the suture to perform an instrument tie or secured using an Aberdeen knot tie.
Aberdeen Knot
The Aberdeen knot is secured by holding the needle-end of the suture in one hand, and reaching through the loop to grab the needle-end and pull the bottom edge of the suture material through the loop while holding the top end secured. This creates a new loop and the process is repeated four to five times. For the final knot, the needle is passed through the loop and pulled tight. Then the excess suture material is cut to leave a small tail.
Locked Percutaneous
Lock stitches are a variant of running percutaneous for higher tension wounds or linear wounds with a slight curvature. This is a rapid method with less chance of dehiscence than regular running percutaneous, but allows for less tissue swelling and increases the risk of tissue strangulation.
Start at one end of the wound. Throw the needle from far to near side and tie knots as you would for a simple interrupted stitch.
Then cut the shorter, free tail of the suture, but leave the suture on the needle-end attached.
When throwing the needle, leave slack to create a loop of suture material on the far side of the wound.
Pass the needle through the loop prior to pulling the slack.
Then continue to place the next bite.
Enter with the needle again on the far side of the wound and take repeated bites, spaced approximately one centimeter apart down the length of the wound.
Lock each stitch and secure the final throw using the same instrument tie as the running percutaneous technique.
Common Pitfalls
With each bite, be sure to throw the needle perpendicular to the wound. Use your pickups to pull the wound edges together and ensure that the wound margins align and your throw is 90 degrees with respect to the laceration edge.