Indication

Simple interrupted dermal sutures (more commonly referred to as deep dermal or deep 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, 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. Options include polyglactin (vicryl) or braided lactomer (polysorb). Size 3-0 or 4-0 is generally appropriate depending on the body location and how much tensile strength is needed.

Technique

1. Enter from deep to superficial, exiting at the dermo-epidermoid junction
2. Rearm the needle driver
3. On the opposite side, enter from superficial to deep, existing at the reticulo-dermal layer
4. Instrument tie, cut close to the knot