Chapter 4.12: The Running Set-Back Dermal Suture

Synonym

Running Kantor suture; running set-back suture

Application

This approach is best used in areas under mild to moderate tension, as it is a running technique that allows rapid placement of multiple buried suture throws. It may be utilized in a variety of anatomic locations, including the face, neck, and extremities. While it may be utilized on the trunk, interrupted set-back sutures are generally more appropriate in this location.

Since it is a running technique, it may be associated with a higher risk of dehiscence, as interruption of the suture material in any point in its course would lead to loss of effectiveness of the entire suture line. Therefore, it is often used in concert with other sutures techniques rather than as a sole closure approach.

Suture Material Choice

Suture choice is dependent in large part on location. Though this technique is designed to bite the deep dermis and remain buried well below the wound surface, the surgeon may choose to utilize a larger gauge suture than would be used for an equivalently placed running simple or running buried vertical mattress suture.

On the extremities, a 3-0 or 4-0 absorbable suture material may be used, and on the face and areas under minimal tension a 5-0 absorbable suture is adequate. While this approach should probably not be routinely utilized on the back, using a 2-0 absorbable suture on the back with this technique results in only vanishingly rare complications, since the thicker suture remains largely on the underside of the dermis, and suture spitting is an uncommon occurrence.

Braided suture material will allow for better locking of the suture in place, though it will also impede the surgeon’s ability to pull suture material through multiple loops, and therefore adequate suture material should be pulled through with each loop. Monofilament absorbable suture material will pull through more easily, though the lower coefficient of friction means that it will easily slide back through the wound and it will therefore not lock in place until tied.

Technique

1. The wound edge is reflected back using surgical forceps or hooks. Adequate visualization of the underside of the dermis is required.

2. While reflecting back the dermis, the suture needle is inserted at 90 degrees into the underside of the dermis 2-6 mm distant from the incised wound edge.

3. The first bite is executed by traversing the dermis following the curvature of the needle and allowing the needle to exit closer to the incised wound edge. Care should be taken to remain in the dermis to minimize the risk of epidermal dimpling. The needle does not, however, exit through the incised wound edge, but rather 1-4 mm distant from the incised edge. ...