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  • Over the past several decades, suture materials have improved dramatically.

  • The needle may be as or more important than the suture material itself in promoting an ideal surgical outcome.

  • Keep in mind that the greatest differentiator between suture brands is needle quality rather than the suture material itself.

  • Knot tying should be performed with an eye to creating a secure knot without adding undue bulk to buried sutures.

image Beginner Pearls

  • Most needles used for skin and soft tissue reconstruction are 3/8 circle in diameter and reverse cutting.

image Expert Pearls

  • A semicircular P-2 needle may be used for narrow closures, such as those sometimes encountered on the nose, and a cutting needle, with the sharp edge on the inside of the curve, may be useful for nasal reconstruction where the thin atrophic dermis may be cut by the superficially running outside edge of a reverse cutting needle.

  • Since cutting and reverse cutting needles have a triangular tip, the orientation of the cutting end is indicated by whether the triangle on the box is pointing up (cutting) or down (reverse cutting).

  • In order to minimize the risk of needle-stick injury, it is possible to grasp the suture material approximately 6 to 10 cm from the needle swage between the thumb and index finger of the left hand, allowing the needle to drop down below the hand. Since the needle is hanging freely and is not under tension, there is little chance for a needle-stick injury.

  • Attention to technique, coupled with choice of a sufficiently large needle for the closure in question, may go a long way to optimizing surgical outcomes.

image Don’t Forget!

  • Any suture, including absorbable sutures, may be used for transepidermal suture placement, which may permit the use of a single suture pack for both buried and epidermal sutures.

image Pitfalls and Cautions

  • A single click of the needle driver locking mechanism is sufficient for locking the needle, and cranking down on the needle driver excessively will result in a loosening of the locking mechanism, leading to inadvertent suture needle slippage in the future.

  • The most frequent error encountered by novice dermatologic surgeons is using a needle that is too small for a given anatomic location, or using a technique that does not permit the needle to pass naturally and smoothly through tissue.

  • When tying a deep suture, it is generally desirable to pull the suture strands together as tightly as possible, secured with a stable knot. For transepidermal sutures, since the goal of suture placement is wound-edge apposition, placing the minimal necessary tension across of the surface of the wound is a must; over-tightening these sutures will lead directly to strangulation, necrosis, and—at a minimum—track mark formation.


Over the past several decades, suture materials have improved dramatically. Three thousand years ago, suture ...

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