How to Perform a Subcuticular Suture [with Video Instructions]

Wound closure is a key part of skin and soft-tissue repair, and choosing the right method is important for the best results.

Two main types are used in practice, percutaneous sutures, which pass through the full thickness of the skin, and subcuticular sutures, which stay within the dermis. 

Percutaneous sutures are strong and work well for high-tension wounds but can leave visible marks, while subcuticular sutures keep all material under the skin, giving a cleaner, more cosmetic result.

In this post, you’ll learn how to perform subcuticular sutures with confidence. We’ll explain when to use them, the tools you need, and the difference between running and interrupted methods.

What is a Subcuticular Suture?

A subcuticular suture is a buried stitch placed just under the epidermis to bring skin edges together. Because the suture stays below the surface, it heals without the puncture marks seen in traditional sutures, which can leave a visible “ladder” pattern. 

This makes subcuticular sutures ideal for low-tension wounds where appearance matters. They are especially useful for elective surgical incisions, where tension and contamination can be controlled, providing excellent cosmetic results.

Indications

• Elective surgical wounds 
• Low-tension lacerations 
• Cosmetic closures 

Contraindications

• Heavily contaminated wounds 
• Wounds under high tension 
• Poorly perfused tissue 
• Wounds requiring layered closure

Tools & Materials Needed for Subcuticular Sutures

Successful subcuticular sutures depend on using the right materials and having proper instruments ready. Because you work in the superficial dermis, you need needle and suture types designed specifically for this layer.

Having everything organized and within reach before you start prevents frustrating interruptions that break your sterile field or compromise technique.

1. Needles

Choose needles based on the tissue and level of control needed. For tougher skin, use reverse cutting needles to reduce tissue damage. In contrast, delicate facial areas require tapered needles to minimize disruption. 

To improve precision in shallow skin layers, small circle needles (3/8 or 1/2) provide better control. Finally, always match the needle size to the suture and tissue thickness.

2. Suture Materials

Absorbable monofilaments such as poliglecaprone (Monocryl) are considered the gold standard for subcuticular closure. For fine and delicate facial work, 4-0 or 5-0 sutures are preferred. 

In comparison, trunk and extremity wounds require stronger support, making 3-0 or 4-0 sutures more appropriate. 

Additionally, the monofilament structure allows the suture to glide smoothly without fraying during multiple tissue passes.

3. Needle Driver

Use a fine-tipped needle driver to allow precise control, with a secure locking mechanism to keep the needle stable. 

At the same time, choose a driver with a comfortable grip that fits your hand and the working space. 

Finally, ensure the jaws are smooth so they hold the needle firmly without damaging the suture material.

4. Forceps

Use fine-tipped forceps with teeth, such as Adson forceps, to handle tissue gently. Because the toothed design provides better grip, it reduces the need for crushing pressure compared with smooth forceps. 

In addition, choosing the appropriate forceps length helps ensure comfortable manipulation and prevents hand fatigue.

5. Scissors

Use Iris or fine Metzenbaum scissors specifically for cutting sutures. Because sharp blades cut cleanly, they prevent crushing or fraying of monofilament material. In addition, fine tips allow precise trimming close to buried knots.

6. Sterile Setup and Supporting Supplies

Set up a sterile field using a fenestrated drape to isolate the area. Clean the wound with antiseptic solution and sterile saline, then use local anesthetic for patient comfort. 

During closure, use sterile gauze to control bleeding without disturbing sutures. Ensure good lighting for clear visualization, and always wear sterile gloves and proper protective equipment.

Patient Preparation and Wound Assessment Before Suturing

Proper preparation is essential for a successful subcuticular closure. Even good suturing can fail if the wound is not clean, numb, or appropriate for this technique.

Start by irrigating the wound with sterile saline to remove debris, clots, and contaminants. After cleaning, provide adequate anesthesia based on the wound’s size and location to ensure patient comfort. 

Next, carefully debride any nonviable tissue, since damaged tissue can delay healing and weaken the repair.

Next, determine if the wound needs layers or just a subcuticular closure. Deep or high-tension wounds require dermal sutures first to support the tissue and reduce stress.

If fat or fascia is visible, or if the wound edges gape, deep sutures are needed. Only shallow, low-tension wounds with easily approximated edges should be closed with a subcuticular layer alone.

What are the Differences Between Running vs Interrupted Subcuticular Techniques?

Subcuticular sutures can be placed using either interrupted or running patterns, and understanding when to choose each method directly impacts your efficiency and outcomes.

The techniques differ fundamentally in how they distribute tension and how much control you maintain over individual sections of the wound.

How to Perform Subcuticular Sutures

Video by Stanford Surger, “Subcuticular Suture”, YouTube

1.Start by selecting a clear monofilament suture, such as 4-0 Monoril, on a cutting needle. Hold an ATS forceps in your non-dominant hand and the needle driver in your dominant hand, ready for precise handling.

2. Place a single deep dermal stitch at the apex of the wound to anchor the suture. Tie the knot and cut the free end short so it remains buried beneath the skin.

3. Load the needle backhand and place the first stitch from deep to superficial, exiting near the epidermal-dermal junction. This starts the hidden subcuticular layer without leaving visible marks.

4. Advance the suture along the incision in a side-to-side motion at the level of the epidermal-dermal junction. For each bite, evert the skin edge, insert the needle at the junction, follow the curve of the needle, and exit at the same level.

On the opposite side, insert slightly behind the previous exit to avoid gaps. Repeat until near the end of the wound.

5. You can use forceps to stabilize the skin near the needle exit instead of holding the needle directly. Advance the needle about two-thirds through the tissue, then reposition it in the needle driver for the next bite.

6. At the end of the wound, insert the needle at the opposite apex. Choke up on the needle for better control and leave a small loop instead of pulling the suture fully through.

7. Release the needle, hold the needle end taut, and pass the free strand through the loop a few times, tightening with each pass. Pull the needle through the loop to lock the knot.

8. Finally, take a wide bite of tissue at the apex to exit through the skin and cut the suture flush with the surface, keeping the knot fully buried for a neat, invisible closure.

Common Mistakes When Performing Subcuticular Sutures & How to Avoid Them

Even experienced practitioners can fall into technical traps when placing subcuticular sutures. Understanding these common errors helps you avoid complications that undermine your careful work.

Practice Your Subcuticular Suture Technique with Artagia Med's Training Kits

Building competency with subcuticular sutures requires practical experience using materials that accurately replicate real tissue. 

The Advanced Suture Practice Kit for Medical Students from Artagia Med offers a comprehensive training solution featuring practice pads, complete surgical instrument sets, and diverse suture materials to master all closure methods. 

Those beginning their suturing education will find the Basic Surgical Knot Tying Practice Board Kit particularly valuable, with its durable board, quality rope, and knot trainer designed to develop correct technique and build foundational confidence. 

When your abilities advance, the Advanced Surgical Knot Tying Board Kit provides the complexity required for realistic clinical preparation through variable tension settings, anatomical reference points, and professional-grade instruments that mirror actual procedural tools. 

Place your order for suture training kits today to cultivate the competence and technical skill essential for professional wound management.