Continuous Subcuticular Sutures Preferred for Clean Surgical Incisions

Evidence on Comparative Outcomes

Continuous subcuticular suturing reduces wound dehiscence by approximately eight‑fold compared with interrupted non‑absorbable transcutaneous sutures in clean incisions, while surgical site infection rates remain equivalent (RR 0.08; 95 % CI 0.02–0.35 for dehiscence, RR 0.73; 95 % CI 0.40–1.33 for infection)【1】.
No clinical scenario in clean wounds demonstrates superior outcomes for interrupted sutures over continuous subcuticular closure【1】.

The World Society of Emergency Surgery issues a strong (Grade 1B) recommendation to use continuous subcuticular closure rather than interrupted sutures even in emergency settings【1】.

Knot tension – Each knot should be tied with minimal tension, just enough to approximate edges without blanching; over‑tightening markedly raises dehiscence risk【1】.
Suture material for skin – Non‑absorbable monofilament (nylon or polypropylene) is the first‑choice material, with planned removal on postoperative days 7–9【1】.
Avoid absorbable skin sutures – Absorbable sutures do not provide sufficient prolonged support for interrupted skin closure【1】.
Removal timing – Remove interrupted skin sutures between postoperative days 7–9 to maintain wound support while minimizing permanent suture marks【1】.
Deep dermal closure – When absorbable sutures are used for deep dermal layers, synthetic monofilament that retains 50‑75 % of its tensile strength after one week is preferred【1】.

In contaminated or dirty wounds with purulent material, delayed primary closure (2–5 days after initial open management) may employ interrupted sutures for skin closure【2】.
For contaminated emergency laparotomy cases, a delayed primary closure with revision 2–5 days post‑operatively is recommended over immediate primary closure with interrupted sutures【2】.

Quilting sutures in the subcutaneous layer should be used to eliminate dead space; routine subcutaneous drains do not reduce surgical‑site infection rates【2】.
Subcutaneous drains are not recommended routinely; they may be considered only for specific high‑risk patient groups【2】.

Adhesive steri‑strips should not be applied over any suture technique, as they do not lower infection or dehiscence rates【1】.
Interrupted transcutaneous sutures should be avoided for clean incisions; continuous subcuticular closure remains the evidence‑based preferred method【1】.
No evidence supports routine restriction of physical activity after open abdominal surgery, regardless of the closure technique used【2】.