Running (continuous) sutures

A running suture, also known as a continuous suture, consists of one

strand of suture material that runs for a lengthy distance along a wound,
normally in a zigzag pattern, which is tied at either end. This suture
resembles those used on baseballs, and so, they are sometimes called
baseball sutures. Running (continuous) sutures provide an adequate
closure with even tension distribution as well as saving both time and
suture material. This technique is commonly used when the wound is
actively bleeding and thus where time is of essence, such as a scalp
laceration.

The disadvantage is that suture breaks can cause wound gaps to occur.

Running/continuous sutures
Use running sutures when esthetics are not important and when you want
to save time. Running sutures will tend to bunch-up the tissue and shorten
the wound length due to the tension needed to keep the wound margins
together. Use the running suture on an actively bleeding scalp wound, time
is important to minimize blood loss and being in the hairline in most cases
the cosmetic result is usually not critical.

Running sutures spreads the suture tension on evenly all over the wound
and this may be important when working with tissue with a soft consistency.

If the suture material breaks in a running suture the whole wound will break
down so be sure to secure the knots on the 2 sides properly and consider
adding a couple of strategically placed interrupted sutures in addition to the
running suture.

Continuous interlocking sutures

This suture technique is accomplished by passing the needle through the
loop created by the previous suture, locking it into place. Continuous
locking sutures are commonly used for breast reconstructions, intestinal
surgeries, and hernias, where soft tissue requires secure stitching. The
downside when used externally on the skin is that continuous locking
sutures may leave permanent hatch marks.

There is very little difference between the regular running and the
interlocking running sutures. The latter is supposed to seal the wound
margins better and this may be important if one is closing a wound
between two cavities e.g. closing the incision between the oral and nasal
cavities following a Le Fort 1 osteotomy.

Subcuticular sutures
Apposition of the wound edge is easily achieved using the subcuticular
continuous suture. Minimal scarring occurs because external sutures are
not used. Rather the subcuticular suture is applied under the epidermis
using either an absorbable suture or a non-absorbable suture leaving
external knots at the far ends of the laceration or incision so that the suture
can be removed easily. When applied correctly, subcuticular continuous
sutures provide the best outcome for cosmetic results. However, the
procedure is extremely time-consuming. These sutures are easily removed
and commonly used on children for this reason.

The subcuticular suture will allow for a very pleasing esthetic result in most
cases, but it offers very little wound eversion by itself. Surgeons will have to
get wound eversion by properly placing the subcutaneous sutures if they
intend closing the surface with subcuticular sutures. One can either use
absorbable or non-absorbable sutures when placing subcuticular sutures. If
the choice is a thin Nylon suture remember to remove the suture within 5
days to avoid having to dissect out fragments of suture material from the
semi-healed wound margin. Strengthen the wound margins with Steri-
Strips if needed when closing with subcuticular sutures.

Purse-string sutures
The purse sting suture in essence is a running suture used to close round
defect wounds or openings. Predictably, the purse-string suture will not
give good cosmetic result because this suture will bunch-up the tissue.
Purse-string sutures are typically used to close circular objects such as an
areola or to close the opening after removing a chest drain (instruct the
patient to take a deep breath and forcibly exhale against closed nose and
lips). The suture material is passed in and out of the tissue as a running
stitch and then drawn closed like closing a purse or a bag.