006: Running Sutures Are A Sign Of Weakness

In this episode, I explain the meaning behind the provocative title "Running Sutures are a Sign of Weakness." This mantra originates from my formative experience observing renowned plastic and reconstructive surgeons at Johns Hopkins Hospital during my anesthesia fellowship. I was intrigued to find the esteemed Dr. Paul Manson and his entire team used interrupted sutures exclusively when closing their incisions.

Key Lessons from Johns Hopkins Surgeons

Working in the OR with Dr. Manson, I heard him utter the phrase “running sutures are a sign of weakness” frequently. This piqued my interest, so I asked him and his colleagues to explain their philosophy.

They firmly believed running or continuous sutures have less integrity than interrupted. If a knot comes undone or the suture line is disrupted during the healing phase, the entire closure can catastrophically unravel and wound dehiscence can occur. 

After exploring a spectrum of suturing techniques during oral surgery residency, I decided to adopt interrupted sutures for most closures in my own practice. Through repetition, I became highly proficient at efficiently placing interrupted sutures and securing them with instrument ties.

Additional Closure Techniques

While interrupted sutures are my workhorse, I integrate a few other techniques when indicated:

  • Figure eight sutures to secure grafted tooth sockets and prevent micromotion. The crossovers add stability.
  • Horizontal mattress sutures in areas of thin, friable tissue without attached gingiva. These distribute tension over broader area.
  • Rarely running sutures anymore given the plastic surgeons’ wisdom that they represent weaker closure.

Suggestions for Listeners

I suggest listeners experiment with various suturing techniques early in their careers to find preferences. Eventually narrow down to just a few you can master through repetition. I welcome hearing from dentists about their own favored suture types and experiences at [email protected].

In closing, the mantra from Johns Hopkins guides my approach. While versatile in residency, I now reach for interrupted sutures in the vast majority of cases thanks to their reliability.