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This time, I will show you how to manage
deeper layers of wounds

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using deep dermal sutures.

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A simple interrupted buried suture
is a classic example.

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Stay tuned!

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Deep dermal sutures are always applied

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when a wound’s edges must be
adapted before application.

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This will reduce tension
and separation of its layers.

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Absorbable threads are always used
for deep dermal sutures.

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Simple interrupted buried sutures are almost
identical to the simple interrupted sutures

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that we learned about
in one of the previous videos.

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The key difference is that the knot is
directed inside the wound instead of outside.

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To make a deep dermal suture, lift the left
edge of the wound with the forceps,

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make a puncture
in the subcuticular tissue,

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and withdraw the needle from the skin,
this time at a shallower depth.

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It is important to move the needle from
the medial part of the wound to the lateral part,

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and from the deeper layer
to the shallower layer.

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It is crucial that you don’t accidentally move
onto the skin surface during puncturing

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as the whole suture needs to be
concealed inside the wound.

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After making the first puncture, pull the needle
and part of the thread through the wound,

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and then make an equivalent puncture
on the other side.

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To do this,
grab the right edge of the wound,

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make a puncture
in the superficial layer of the wound

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and move the needle
to the subcuticular tissue.

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This time, the needle should move
from the lateral part to the medial part,

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and from a shallow depth
to a deeper depth.

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It is also important that
both thread ends are on the same side

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after the second puncture
has been made.

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If it turns out that they are pointing
in two different directions,

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use the needle holder
to pass the needle under the thread

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and pull the remaining fragment,
so that both ends are on the same side.

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Then, pull the thread in such a way as to leave
a couple of centimeters free to tie a knot.

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Tie a surgical knot as we did
for all previous sutures,

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only this time pull the knot
along the wound and not across.

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Then, trim both thread ends short
so that the whole knot is under the skin.

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Move the scissors along the thread
as close as possible to the knot,

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hold them at an angle, and trim both 
thread ends with the tip of the scissors.

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After trimming the thread, no part of it
should be visible on the surface of the skin.

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And that’s how to make
a deep dermal suture.

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In the next video, we will move to
one of the most difficult surgical sutures,

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i.e. a continuous intradermal suture.

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See you soon!

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