The running butterfly suture: A novel, everting alternative to the running subcuticular technique

SOLUTION The running butterfly suture is a novel approach to closing wounds under minimal tension. The technique is performed as follows: with the wound oriented parallel to the surgeon’s body, the needle is inserted through the outside of the wound, lateral to the apex, exiting in the interior of the wound. Alternately, a buried anchoring suture, such as a simple buried suture, buried vertical mattress suture, or set-back dermal suture, may first be placed. The far wound edge is then gently reflected back with the forceps, as the needle enters at the junction where the base of the incised wound edge meets the undersurface of the dermis (Fig 1). The needle then proceeds on a diagonal course, angling upward toward the surface of the skin and outward away from the wound edge, before exiting again at the base of the undermined wound edge, further along the length of the wound than its entry point (Fig 2). The needle is then reloaded, and the procedure is repeated on the contralateral wound edge. As when using the standard running subcuticular technique, the entry point on the contralateral wound edge should be slightly backtracked from the exit point on the prior side to reduce the risk of tissue bunching. Alternating bites on each side of the wound are taken until the end of the wound is reached, at which time either a final anchoring suture may be placed or the suture material can exit lateral to the apex and be secured, leaving a well-everted wound (Fig 3).