Simple Continuous Stitch

Simple Continuous or Running Suture (Baseball Stitch)

Wayne W. LaMorte, M.D., Ph.D., M.P.H.

Photography by Michael J. LaMorte

A simple continuous stitch can be a useful technique for skin closure when speed is important, e.g. closing a scalp laceration on a screaming child.

The simple running, or continuous suture, is begun in the same way as a simple interrupted suture. Again, it is important to grasp the skin and evert it slightly using a fine toothed forcep, and the needle holder is rotated into a pronated position in preparation for piercing the skin.

The needle is then driven through the full thickness of skin by supinating the wrist to rotate the needle and pass it through the skin.

The wrist is then pronated again in order to regrasp the needle, and the wrist is then supinated to complete passage of the needle through the skin.

This process is repeated for the skin edge closest to the surgeon.

Once the second “bite” has been taken, the suture is tied off using square knots, just as if it were a simple interrupted stitch, except that only the short strand is cut, leaving about a 3-4 mm tail.
Here, the first stitch has been tied off, and the surgeon prepares to place a second stitch about 3 mm away from the first.

It is easier to get precise apposition of the wound edges by having the needle traverse the wound perpendicularly. This results in a diagonal stitch exteriorly as the needle is advanced 4 mm further down the wound for the next bite. Alternately, one could pass the needle diagonally with each bite, but generally perpendicular needle tracts are preferred.

The last stitch is not pulled completely through. Instead, the loop which is being held with the needle holder here will be used as the short strand in order to tie off the distal end of the suture closure.

The surgeon grasps the loop in the right hand and begins creating the first throw of a two-handed square knot.

The loop is drawn across the long strand…

… and the short end loop is passed to the thumb and index finger of the left hand.

After rotating the short end loop up through the first throw, the short end loop will be regrasped by the right hand.

The short end [loop] and the long strand are then drawn in opposite directions to approximate the skin edges.

The second throw of the square knot is then begun.

The short end [loop] has been drawn beneath the long strand and then rotated up and away from the surgeon.

Here, the short end is being passed to the thumb and index finger of the left hand, which will rotate the short end clockwise.

Additional alternating throws are added to secure the knot, and all three strands (1 from the long strand and 2 from the short loop) are cut 3-4 mm from the knot.

This results in 3 strands sticking up from the completed knot at the distal end.