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My way of closing an incision. I use 3-0 vicryl for my deep dermal sutures, then 4-0 monocryl in a subcuticular fashion.
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I start my deep dermals in the middle of the incision and split the incision into sections. Then I divide those sections into smaller ones. This helps me keep the incision even. This is the strength layer of the incision.
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The subcuticular closure can be done in several different ways. I like to go deep to superficial right at the corner to start the stitch. I tie a knot, then bury it with another deep to superficial throw. Then I take small bites in the corner, and gradually take larger bites until I get to the other corner. Notice how I try to be efficient and minimize unnecessary moves by setting myself up at the end of each throw, putting the needle in position for the next stitch. This saves time from having to reposition the needle after each throw. I also pull on the suture after each throw to make sure I don’t leave any gaps. At the end of the incision, I leave the suture loose because if you pull it tight in the corner, it makes it very hard to put in the last couple throws. An Aberdeen knot is used at the end, and the knot is buried at the end. Dermabond is then used to seal the incision after it is cleaned.
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The zig zag appearance disappears and the monocryl dissolved and the final incision is a clean, straight line.
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