How to Perform a Deep Dermal Suture [with Video]

Most wounds you’ll close in training and your career won’t be simple cuts that need just a few stitches. You’ll face deep lacerations under tension, wounds with dead space, and injuries where surface closure alone often fails.

This is why learning how to perform deep dermal sutures correctly is essential for proper wound management. This technique reduces tension on the skin edges, closes dead space, and provides structural support for stronger healing.

By the end of this post, you’ll know when to use deep dermal sutures, how to place them correctly, and which surgical tools and materials help ensure reliable, safe results.

What is Deep Dermal Suture? 

A deep dermal suture is a buried stitch placed within the dermal layer, with the knot completely hidden under the skin. This internal placement reduces tension and closes dead space to support stronger, smoother healing. It’s commonly used in deeper wounds and in plastic surgery to improve cosmetic outcomes.

When to Choose Deep Dermal Sutures

• Deep wounds under tension or with significant dead space.
• Areas where you want minimal tension on skin surface or better cosmetic outcome.
• Situations when layered closure helps reduce scar formation or reduces risk of wound dehiscence.
• When absorbable buried sutures can simplify patient follow-up (less need for suture removal).

Contraindications of Deep Dermal Sutures

• Heavily contaminated wounds present too much infection risk for buried sutures
• Very thin dermis may not provide enough tissue to support buried sutures properly
• Areas with poor tissue viability or limited blood supply can lead to necrosis, infection, or complete wound breakdown

Tools & Materials Needed for Deep Dermal Sutures

Success with deep dermal sutures begins by preparing the proper materials and instruments before starting. Having everything ready ensures the procedure goes smoothly.

1. Sutures

Typically, absorbable sutures are used for deep dermal closures. These sutures naturally break down over time as the wound heals, which means you won’t need to remove them later.

Monofilament sutures, such as Monocryl, glide smoothly through tissue and create minimal drag. They also carry a lower risk of infection, making them ideal for many situations.

Braided sutures, like Vicryl, offer excellent knot security and handling, which some practitioners find easier to work with.

Choosing between monofilament and braided sutures depends on the wound location, tissue type, and your personal experience with each material.

2. Needles

Choosing the right needle is just as important as selecting the suture. Using the wrong needle can damage tissue or make placing the suture unnecessarily difficult.

A curved, reverse-cutting needle in a 3/8 circle works best for buried dermal sutures. Its design allows the needle to pass smoothly through the dense dermal layer without causing trauma.

The reverse-cutting edge places the cutting surface on the outer curve, which helps prevent the needle from slicing through tissue as it moves through the wound.

3. Instruments

Choose instruments carefully to make deep dermal suturing easier and safer. A reliable needle holder or driver ensures secure control of the needle throughout the procedure.

Toothed forceps help handle tissue gently and evert skin edges without crushing delicate structures.

Sharp scissors, like Metzenbaum or Iris scissors, are essential for trimming suture ends flush with the buried knot without disturbing surrounding tissue.

How to Perform Deep Dermal Sutures

Mastering the deep dermal suture technique requires understanding each step and how they build upon each other to create a secure, well-approximated wound closure.

Video by Stanford Surger, “Deep Dermal Suture Tutorial”, YouTube.

1. Prepare the wound and workspace – Clean the wound with sterile saline, drape the area, and ensure local anesthesia is administered if needed. Arrange all instruments and materials within reach.

2. Select suture and needle – Choose the appropriate absorbable suture and needle for the wound. Mount the needle securely and have forceps and scissors ready.

3. First bite – Insert the needle from the deep dermal layer toward the dermo-epidermal junction on one side of the wound, avoiding fat or superficial skin.

4. Second bite – Mirror the first bite on the opposite wound edge, inserting from the dermo-epidermal junction downward into the deep dermal layer.

5. Tie and bury the knot – Pull the suture ends gently to bring dermal edges together. Tie a secure knot with at least three throws, keeping it buried beneath the skin.

6. Trim suture ends – Cut tails to about 2–3 mm to prevent extrusion while maintaining knot security.

7. Repeat as needed – Place additional deep dermal sutures spaced 5–10 mm apart along the wound, adjusting for tension and depth.

8. Add surface closure – Finish with interrupted sutures or subcuticular sutures for epidermal alignment, using minimal tension since the deep layer provides support.

Aftercare for Deep Dermal Sutures

To ensure proper healing after having deep dermal sutures, follow the aftercare steps below carefully.

• Dress the wound using standard procedures for laceration aftercare.
• Splint any adjacent joints (e.g., an elbow or wrist) if their movement could cause tension on the suture line.
• Keep the dressing dry and in place, and plan to return for a wound check in approximately 2 days.
• Return immediately if any signs of infection develop (e.g., increased pain, swelling, redness, fever, or red streaks spreading proximally).
• Suture removal schedule (Note: Removing sutures too early risks the wound reopening):
• Face: 3 to 5 days (sometimes partial removal is done earlier to minimize scarring).
• Scalp and Trunk: 6 to 10 days.
• Arms and Legs: 10 to 14 days.
• Wounds over Joints: 14 days or longer.

Common Mistakes When Performing Deep Dermal Sutures & How to Avoid Them

Even experienced practitioners occasionally make technical errors that compromise wound healing or cosmetic outcomes when placing deep dermal sutures. 

The table below highlights key errors and how to avoid them.

Practice Your Deep Dermal Suture Technique with Artagia Med's Training Kits

Artagia Med’s Advanced Suture Practice Kit for Medical Students delivers a complete training experience with practice pads, full surgical instruments, and a variety of suture materials to cover all wound closure techniques.

If you are a beginner looking to improve your knotting skills, our Basic Surgical Knot Tying Practice Board Kit is an ideal choice. It includes a sturdy board, premium rope, and a knot trainer to help you develop proper technique and build confidence.

As your skills progress, the Advanced Surgical Knot Tying Board Kit introduces multiple tension settings, anatomical markers, and specialized instruments to simulate realistic clinical scenarios.

Order your suture training kits today to start building the confidence and skills you need for professional wound closure.