Absorbable Continuous Subcuticular Sutures for Skin Closure

Efficacy

The World Journal of Emergency Surgery guidelines (2020) give a strong recommendation (Grade 1B) that using an absorbable continuous subcuticular suture (4‑0 poliglecaprone or 4‑0 polyglactin) markedly lowers superficial wound dehiscence compared with interrupted sutures while keeping surgical‑site infection rates equivalent. [1][2]
Continuous subcuticular suturing achieves an approximately 8‑fold reduction in superficial wound dehiscence (RR 0.08; 95 % CI 0.02–0.35) versus interrupted non‑absorbable transcutaneous sutures. [1][3]4
No statistically significant difference in superficial surgical‑site infection is observed between continuous and interrupted techniques (RR 0.73; 95 % CI 0.40–1.33). [2][5]
Length of hospital stay is comparable for continuous subcuticular and interrupted suturing methods. [1][4]

4‑0 poliglecaprone (Monocryl) retains roughly 50‑75 % of its original tensile strength after one week in situ, providing prolonged wound support. [6][4]
4‑0 polyglactin (Vicryl) exhibits a similar tensile‑strength retention profile over the first postoperative week. [6][7]

Vertical or horizontal mattress sutures (interrupted) are associated with higher wound‑dehiscence rates than continuous subcuticular sutures. [1][3]
Mattress sutures placed transcutaneously leave visible suture marks, compromising cosmetic outcomes. 2
No guideline‑level evidence supports routine use of mattress sutures for skin closure. [2][7]
Non‑absorbable standing (interrupted transcutaneous) sutures are inferior to continuous subcuticular sutures regarding wound‑dehiscence outcomes. [1][4]2

The continuous suture must be placed subcuticularly (beneath the epidermis) to achieve optimal cosmetic results and to reduce dehiscence. [1][2]
Over‑tightening the continuous suture can strangulate wound edges, negating its benefits. [2][5]
Adding adhesive steri‑strips over subcuticular sutures does not improve clinical outcomes and is therefore not recommended. [1][6]

Although the recommendation is strong (Grade 1B), the underlying evidence derives primarily from studies in pediatric and adolescent appendectomy patients, introducing some uncertainty when extrapolating to other surgical populations. [4][2]

The World Journal of Emergency Surgery guidelines issue a strong recommendation (Grade 1B) for using absorbable continuous subcuticular sutures (4‑0 poliglecaprone or 4‑0 polyglactin) instead of other skin‑closure techniques. 8

Continuous subcuticular suturing reduces superficial wound dehiscence by approximately eight‑fold compared with interrupted non‑absorbable transcutaneous sutures (Risk Ratio 0.08; 95 % CI 0.02–0.35). 8
There is no statistically significant difference in surgical‑site infection rates between continuous subcuticular and interrupted techniques (Risk Ratio 0.73; 95 % CI 0.40–1.33). 8
Length of hospital stay is comparable between continuous subcuticular sutures and interrupted suturing methods. 8
Applying adhesive steri‑strips over continuous subcuticular sutures does not improve clinical outcomes or cosmetic appearance. 8

The 4‑0 poliglecaprone suture retains approximately 50–75 % of its original tensile strength after one week in situ, providing prolonged wound support during the critical early healing phase. 8

The primary evidence base derives from young patients undergoing appendectomy, which introduces some uncertainty when extrapolating to other surgical contexts. 8
Additional studies in hepato‑pancreatobiliary surgery, facial plastic surgery, and general abdominal surgery consistently demonstrate outcomes that are equivalent to or better than those achieved with alternative skin‑closure methods. 8

In clean surgical incisions, continuous subcuticular sutures reduce wound dehiscence by approximately eight‑fold compared with interrupted sutures, while infection rates remain unchanged (RR for dehiscence = 0.08, 95 % CI 0.02–0.35; RR for infection = 0.73, 95 % CI 0.40–1.33) 9.
No clinical scenario has demonstrated superior outcomes for interrupted sutures over continuous subcuticular techniques in clean wound closure 9.

When using interrupted sutures, tie each knot with just enough tension to approximate the wound edges without causing blanching; over‑tightening increases the risk of dehiscence 9.
Non‑absorbable interrupted sutures should be removed between postoperative days 7 and 9 to provide adequate support while minimizing suture‑mark formation 9.
Interrupted transcutaneous sutures should be avoided for clean surgical incisions; continuous subcuticular closure is the preferred method 9.
Adding steri‑strips over any suture technique does not reduce surgical‑site infection or dehiscence rates and is therefore not recommended 9.

For interrupted skin closure, employ non‑absorbable monofilament sutures such as nylon or polypropylene when removal is planned at 7–9 days post‑operatively 9.
Absorbable sutures should not be used for interrupted skin closure because they provide insufficient prolonged support compared with continuous absorbable subcuticular sutures 9.
The evidence‑based choices for continuous subcuticular closure are 4‑0 poliglecaprone (Monocryl) or 4‑0 polyglactin (Vicryl); these sutures do not require postoperative removal, reducing patient discomfort and the need for a follow‑up visit 9.

A strong recommendation (Grade 1B) favors continuous subcuticular sutures over interrupted sutures; this recommendation is primarily based on pediatric appendectomy studies, which introduces some uncertainty when applying the guidance to other surgical populations 9.