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provides rapid wound closure, excellent skin eversion, then started 4 mm from the first far throw starting on the
precise wound edge apposition, ability to close wounds opposite side of the anchoring knot [Figure 1c]. This will
under tension, ease of suture removal, and most now produce what appears to be a “double-X” pattern
importantly excellent cosmesis in sensitive areas of the over the wound. Following the second far throw, the next
face such as the temporal brow and forehead. throw is placed midway between the first and second far
throws inside the loop between the first near throw and
TECHNIQUE the second far throw making this the second near throw
[Figure 1d]. This pattern of far-near is repeated for the
Anchoring stitch remainder of the wound.
The Running-X begins with a simple interrupted stitch.
The initial throw is passed from the epidermis on the End stich
opposite side of the wound, through the wound, and After the Running-X is used across the entire wound
then out of the epidermis. A knot is tied and the free end length, the suture is tied off using a final far throw. This
of the suture tail is cut leaving a small tail [Figure 1a]. final far throw is different from the previous far throws
because it is placed only 2 mm from the previous far
Running-X throw as opposed to 4 mm like the previous ones [Figure 1e].
The needle is then picked up, reloaded and inserted in The suture is secured with a knot created using the loop
the epidermis on the opposite side of the anchoring between the previous near exit site and entry of the final
knot approximately 4 mm from the initial stitch (far) far throw, and the end of the suture. The tails are then
and 2 mm from the wound edge. The needle is passed cut short.
perpendicular to the wound edge, across the wound and
through the epidermis on the same side as the anchoring Suture material
knot [Figure 1a]. The suture is pulled through leaving a We prefer to use polypropylene (Prolene, Ethicon,
small loop between the anchoring knot and the entry Somerville, NJ, USA). This suture material provides
point of the first throw. The needle is then thrown at more elasticity and stretch than nylon. This is important
the midpoint between the first throw and the anchoring because it allows for wound edema and decreases the
stitch (near), inside the loop, starting on the opposite risk of tissue strangulation and necrosis. [3]
side of the anchoring knot 2 mm from the wound edge,
with the needle passed perpendicularly though the Time to removal
wound, and ending through the epidermis on the same The Running-X suture is removed at the appropriate time
side as the anchoring knot [Figure 1b]. The next throw is interval for the specific anatomic locations to avoid track

Figure 1: Running-X suture technique. (a) Anchor stitch and first far throw; (b) first near throw midway between anchor stitch and far throw; (c)
second far throw 4 mm distal to first far throw; (d) second near throw midway between first and second far throw; (e) final far throw only 2 mm
distal to penultimate far throw and secured to loop between the last near and last far throw with tails cut
246 Plast Aesthet Res || Volume 3 || July 14, 2016