The Subcutaneous Loop: A Single Suture Technique for Skin Closure after Superficial and Subcutaneous Surgery

Background: Removal of subcutaneous skin masses and certain deep skin injuries results in defects, which demand immediate closure. Although primary closure of these defects in 2 layers is an acceptable solution, this technique has a number of drawbacks, such as extended time consumption upon performance, demand for additional suture material and occasional tissue response or foreign body reaction to retained absorbable stitches leading to infection and its sequelae. Objective: We describe an approach intended to furnish a satisfactory solution to the needs of tissue closure in such cases. The significant innovation of this technique is the closure of both deep and superficial layers of skin in one single suture. Materials and Methods: Our suture combines the advantages of the classic mattress suture together with those of the buried subcutaneous suture. We performed the vertical mattress suture with 3/0 polypropylene or monofilament suture and added a subcutaneous loop to achieve sufficient approximation of deep tissue surfaces. This suture technique was applied in our first 50 cases. The defects were closed without adverse sequelae. No tissue infections were observed. Wound dehiscence occurred in one case after premature suture removal. The stitches were slightly more difficult to remove than regular sutures. Review of the resulting scars exhibited acceptable results similar to those of parallel closure techniques. Conclusions: This easily performed technique yields the benefits of reducing suture cost, annulling foreign body reaction, and resulting in both a functional and aesthetically pleasing outcome. The subcutaneous loop technique has become our standard closure of choice for wounds demanding cutanwous and subcutanwous repair.