The Easy Pull-Out Suture

TO THE EDITOR Since Lord Moynihan famously championed the characteristics of the “ideal suture,”1 new materials and methods of closing wounds have been developed. When choosing a suture technique, a number of factors need to be taken into consideration, such as the site of the wound, strength of closure required, reliability, cosmetic outcome, and ease of insertion. When using nonabsorbable sutures, the process of suturing a wound is only the first of a two-stage procedure. One must also incorporate the suture's ease of removal as a factor for consideration. Suture removal should not result in further trauma to the healing tissues; this is particularly true for areas of the body where the skin is delicate, such as the lateral extension of the lower blepharoplasty incision. It is also very important that suture removal does not cause further distress to the patient. This applies particularly to pediatric patients, in whom suture removal can prove to be a challenge. It is not unheard of for pediatric patients to require a general anesthetic for the purpose of suture removal. The removal of sutures can be traumatic to both the wound and patient. We report a technique of knot tying that facilitates ease of removal with minimal trauma to the wound. We frequently use a technique of knot tying that facilitates a 5-0 or 6-0 monofilament suture. The suture is passed through the wound edges either for an interrupted suture or termination of a subcuticular closure. The first knot is tied with two “throws” and the free end of the suture is grasped with the needle holder close to the wound edge, thereby forming a knot with a loop (Figure 1). The knot is subsequently secured in a normal fashion with two further throws (Figure 2). This provides a tight knot, a cut-free suture end, and a loop of tied suture. A simple suture strip or steristrip can then hold the knot down until removal. Following the desired period of time to allow adequate wound healing, the free end of the knot is gently pulled, releasing the knot and loop, thereby removing the suture in a completely atraumatic manner. This preserves the appearance of the wound edges and minimizes patient discomfort. Formation of a knot with a loop. Completed knot with free end of suture that is pulled, releasing the whole knot/suture. We advocate this technique in instances when simple, interrupted, nonabsorbable sutures are used in areas of thin skin (such as lower blepharoplasty incision closure) or in pediatric patients. The authors have no financial interest in and receive no compensation from manufacturers of products mentioned in this article.