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Review Plastic and Aesthetic Research

How we do it: the Running-X suture

technique

Nathaniel L. Villanueva , Kyle Sanniec , Ronald Mancini 2
1
1
1 Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
2 Oculoplastic and Orbital Surgery, Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX
75390, USA.
Address for correspondence: Dr. Ronald Mancini, Oculoplastic and Orbital Surgery, Department of Ophthalmology, University of Texas
Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA. E-mail: ronald.mancini@utsouthwestern.edu

ABSTRACT
There are a myriad of suture techniques available to close incisions of the brow and forehead,
each with their own advantages and disadvantages. The ideal suture technique would provide
excellent cosmetic results, offer expedient wound closure, optimize skin eversion and wound
edge apposition, and provide excellent cosmetic results. The authors describe a new suture
technique, the Running-X suture, a running horizontal mattress suture that has successfully been
used by the senior author for many years to re-approximate surgical wounds of the brow and
forehead in an expeditious and aesthetic manner.
Key words:
Suture technique; running horizontal mattress suture; forehead incisions; eyebrow incisions

INTRODUCTION also widely used in epidermal closures because of their
ability to produce eversion, compression of wound edges,
The choice of suture technique used to close incisions and close wounds under moderate tension. [3,4] One of the
depends on multiple variables which include anatomic major disadvantages to mattress sutures, both vertical
location, thickness of skin, type of wound, and degree of and horizontal, is they are more prone to become buried
tension. Of the various epidermal skin closure techniques during the healing process, requiring a more tedious
used throughout the body, simple interrupted and simple removal. Combining the advantages of mattress sutures
running sutures are the most common because of the with the time saved using a running technique has been
ease of placement and speed of closure. [1,2] Although widely described, although the wound edge apposition
simple interrupted sutures are easy to place and have a tends to be imprecise. [2]
lower potential to cause impaired cutaneous circulation,
the major disadvantages are that the technique is more Herein, we describe the Running-X suture, a novel
time consuming and produces minimal eversion. The running horizontal mattress suture. This suture
main advantages of using a simple running suture are the technique provides multiple advantages when compared
rapid closure of wounds and its ability to simultaneously to traditional running mattress sutures. The Running-X
approximate the dermis and epidermis. However, its
major disadvantage is poor control of inversion and This is an open access article distributed under the terms of the Creative
eversion of the epidermal edges. Mattress sutures are Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows
others to remix, tweak and build upon the work non-commercially, as long as the
author is credited and the new creations are licensed under the identical terms.
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How to cite this article: Villanueva NL, Sanniec K, Mancini
R. How we do it: the Running-X suture technique. Plast Aesthet
DOI: Res 2016;3:245-7.
10.20517/2347-9264.2015.59
Received: 20-05-2015; Accepted: 30-03-2016

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