Deep Dermal Suture - The MOST Important Suture
A neat skin closure starts below the skin. The surface stitch gets the applause, but the buried dermal stitch often does the hardest work.
A deep dermal suture is a stitch placed in the strong layer just under the skin surface, called the dermis. It brings the wound edges together from underneath. The knot is hidden inside the wound, not sitting on top.
Think of closing a zip on a jacket. The visible zip teeth matter, but the fabric underneath must line up first. If the inside layer is crooked, tight, or gaping, the outside will not look right.
In surgery, this stitch matters for three big reasons:
It hides the knot.
It takes tension off the skin.
It closes empty space where fluid can collect.
In my opinion, it is the single most important suture for any surgeon, and this is how I do it
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