Running and subcuticular stitches

What it is

A running (continuous) stitch closes a wound with one length of suture: it is anchored with a knot at one end, passed across the wound again and again at even intervals, and tied at the other end. It is quick, spreads tension evenly and helps stop bleeding, which suits long, straight, clean wounds with little tension. Its weakness is that a break or a cut stitch can loosen the whole line, and it cannot be partly opened to drain an infection. A locked running stitch, where each loop passes through the previous one, adds haemostasis but strangles more tissue. The running subcuticular (intradermal) stitch runs inside the dermis, with small horizontal bites alternating from side to side parallel to the skin surface, so no thread crosses the skin. It leaves no suture marks and gives the best cosmetic scar, which is why it is common for surgical incisions; it needs clean edges that already meet, often with deep dermal stitches beneath to take the tension.

Indications

• Running: long, straight, clean wounds with low tension, where speed matters.
• Running: oozing edges (a locked running stitch adds haemostasis).
• Subcuticular: clean, linear wounds and surgical incisions where the scar matters (face, neck, visible areas).
• Subcuticular: patients who benefit from not needing stitch removal, when an absorbable suture is used.

Contraindications and precautions

• Avoid running stitches in contaminated, high-risk or bite wounds: you cannot remove a few stitches to drain.
• Avoid in irregular wounds or wounds under uneven tension, where interrupted stitches adjust better.
• Subcuticular needs edges that come together without tension; tension needs deep dermal stitches first.
• Do not pull a running line too tight: it bunches the wound like a purse string and strangles the edges.
• Complex or deep wounds go to a senior.

Equipment

• Sterile gloves, drape, antiseptic, local anaesthetic and irrigation.
• Needle holder, toothed fine forceps, suture scissors and skin hooks if available.
• Running skin closure: non-absorbable monofilament sized for the site.
• Subcuticular: absorbable monofilament (buried ends) or non-absorbable monofilament (pulled out later).
• Adhesive strips and a dressing to support the closure.

Step by step (and why)

1. Prepare, anaesthetise, irrigate and close deep layers if needed — a tension-free, clean wound comes first.
2. Running: place a simple stitch at one end, tie it and cut only the short tail — this anchors the whole line.
3. Running: pass across the wound at even intervals, entering at 90° each time — even bites give even tension.
4. Running: keep the thread snug, not tight, as you go — a tight line puckers like a purse string and strangles edges.
5. Running: finish by tying the needle end to the last loop left long — this locks the line securely.
6. Subcuticular: start beyond the wound end and bring the needle into the dermis at the apex — the anchor sits clear of the wound.
7. Subcuticular: take small horizontal dermal bites, alternating sides, each starting level with or just behind the last exit — avoids overlap.
8. Subcuticular: keep every bite at the same dermal depth, parallel to the surface — uneven depth gives a wavy, stepped scar.
9. Subcuticular: pull up gently every few bites, then bury the knot or tape the tails — even pull closes the edges without bunching.
10. Support with adhesive strips, dress, and explain whether removal is needed — absorbable buried stitches need no removal.

Complications

• Breakage of a running line: the whole closure may loosen.
• Infection that cannot be drained by removing a single stitch; the wound may need to be opened more widely.
• Purse-string puckering or ischaemia from pulling the line too tight; a locked stitch strangles more.
• Subcuticular: stepped or gapping edges from uneven depth; extrusion of a buried knot (a «spitting» stitch).
• Suture marks with running skin stitches left in too long; none with subcuticular closure.

Next step

• Check the line along its whole length: edges meeting, no puckering, no gaps at the ends.
• Tell the patient whether stitches must be removed (non-absorbable) or will dissolve (absorbable buried).
• Advise wound care, adhesive strips left in place until they lift, and the warning signs of infection.
• Return early for redness, discharge or opening; a running line may need full removal and secondary closure plans.
• Call a senior for wounds with tension, irregular edges or contamination where a running closure is doubtful.

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Elsewhere in DurgiPedia

• The surgical wound: healing, dehiscence and infection

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Educational content; it does not replace supervised hands-on training, your institution's protocols or a prescriber's order. A procedure is learnt with a teacher and done only once you are trained to do it.

Sources: Wound Closure Techniques (StatPearls (NCBI Bookshelf), 2023).

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