What & why:
Simple interrupted dermal sutures (more commonly referred to as deep dermal sutures) are sutures placed within the dermal layer to reduce the static tension on a gaping wound.
Suture selection:
In contrast to the epidermal layer, where you will most often be using non-absorbable suture material like nylon, the dermal layer should be closed with absorbable sutures since you won’t be able to remove them later. Ideally, a suture material with minimal tissue reactivity but a longer period of effective wound support is best. I typically use polyglactin (vicryl) or braided lactomer (polysorb) sutures for this purpose. Size 3-0 or 4-0 is generally appropriate depending on the body location and how much tensile strength is needed.
Alternatives:
More sophisticated alternatives exist for a deep suture layer, such as the set-back dermal suture. However for the novice practitioner, the deep dermal simple interrupted is the first stop in learning to manage more complex wounds.
I was trained to pull my knots tight perpendicular to the wound for deep dermal sutures. This would be at a 90 degree angle to that demonstrated in this video. This accomplishes two goals. One it pulls the wound edges closer together thus taking even less tension off the wound edges. Two it buries the knot deeper in further from the skin surface again making stitch abscess less likely. Hope this tip is useful thanks for the great sight!
Great tip! Thanks for the comment and checking out the site.
How do you start an instrument tie for a buried dermal suture? Wrap the suture clockwise or counterclockwise? Necessary to cross hands?
Assuming I am sewing towards myself—which is my habit and I believe the most ergonomic and best way—I will wrap the suture clockwise. If suturing perpendicular, as was suggested by another commentator, shouldn’t need to cross hands. Thanks for viewing!
I would like to thank you for your amazing website, I have learned alot from it especially technique for think skin. Thanks alot
I have a question regarding deep dermal and subcutaneous sutures, is it better regarding infection rates to avoid them and to make simple sutures with big bite ??