Composite subcuticular subcutaneous buried suture

Subcuticular suturing is widely regarded as providing the best cosmesis in skin wounds without tension. Wounds with tension can be modified to make them tension-free and amenable to subcuticular suturing by placing a deeper layer of buried subcutaneous sutures that appose wound edges.1 However, buried subcutaneous sutures pierce the dermis and may interfere with placement of subcuticular sutures in the same layer. Moreover, closure in 2 layers is time-consuming.