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Journal of Environmental Pathology, Toxicology and Oncology
IF: 1.241 5-Year IF: 1.349 SJR: 0.356 SNIP: 0.613 CiteScore™: 1.61

ISSN Print: 0731-8898
ISSN Online: 2162-6537

Journal of Environmental Pathology, Toxicology and Oncology

DOI: 10.1615/JEnvironPatholToxicolOncol.v29.i4.70
pages 363-372

Scientifi c Basis for the Selection of Skin Closure Techniques

Richard Edlich
Legacy Verified Level I Shock Trauma Center Pediatrics and Adults, Legacy Emanual Hospital; and Plastic Surgery, Biomedical Engineering and Emergency Medicine, University of Virginia Health System, USA
K. Dean Gubler
Surgical Critical Care, Legacy Verified Level I Shock Trauma Center for Pediatrics and Adults, Legacy Emanuel Hospital, Portland, OR, USA
Anne G. Wallis
Brush Prairie, WA, USA
Jamie J. Clark
Brush Prairie, WA, USA
Jill J. Dahlstrom
Legacy Verified Level I Shock Trauma Center, Legacy Emanuel Hospital, Portland, OR, USA
William B. Long III
Trauma Specialists LLP, Legacy Verified Level I Shock Trauma Center for Pediatrics and Adults, Legacy Emmanuel Hospital Portland, OR, USA


This scientific article was designed to teach the individual reader the scientific basis for suture and needle selection as well as to illustrate the appropriate surgical techniques involved in wound repair of skin incisions. Because the US Food and Drug Administration permits 1.5% of the sterile surgical gloves to have holes, the operating room personnel should wear sterile surgical double-glove hole indication systems that detect holes in the outer glove. From the surgeon’s point of view, the rate of gain of strength of the skin wound is a key determinant of many decisions including when the suture can be removed, the level of patient activity, and the selection of the incision. Important considerations in wound closure are type of suture and mechanical performance, in vivo and in vitro. Measurements of the in vivo degradation of sutures separate them into two general classes, absorbable and nonabsorbable. Sutures that undergo rapid degradation in tissues, losing their tensile strength within 60 days, are considered absorbable. Those that maintain their tensile strength for longer than 60 days are considered nonabsorbable. For skin closure with nonabsorbable suture, we favor the use of the polybutester suture that is coated with an absorbable polymer, VASCUFILTM. When absorbable sutures are used for a dermal skin closure, the synthetic monofilament MAXONTM is recommended. Absorption of the suture is complete between 90 and 110 days. In either case, we would recommend that the suture be attached by a swage attachment to a SURGALLOYTM reverse cutting stainless steel suture. Continuous percutaneous suture closure has definite, distinct advantages over interrupted suture closure. Although continuous dermal wound closure is technically more challenging for the surgeon than interrupted dermal suture closure, it has become an important wound closure technique. A monofilament absorbable synthetic MAXONTM attached to a reverse cutting edge SURGALLOYTM stainless steel needle is ideally suited for continuous dermal skin suture closure.