throws a single time The first and second throws should be snug enough to approximate the wound edges, but not so tight that tissue is strangulated All subsequent knots are squared to maintain the closure Four or five throws are usually required to keep the knot from unraveling A “loop knot” is effective in apposing the wound edge with minimal tension This involves placing a surgeon’s knot, using the instrument tie, followed by a loop The surgeon’s knot will “give” slightly should edema develop subsequently The loop knot allows easier, painless removal of sutures because it creates a free space between the suture and the skin ( Fig 110.5 ) Running or continuous sutures can be applied rapidly to close large, straight wounds or multiple wounds With this technique, the suture is not cut and tied with each stitch The first suture is placed at one end of the wound and a knot is tied, cutting only the end of thread not attached to the needle The next loop is placed a few millimeters away and continuous loops of equal bites are made to close the wound On the final loop, because the suture is not completely pulled through, a small loop remains on the opposite side of the wound Now, the knot can be tied using the preceding loop of suture ( Fig 110.6 ) This type of stitch is more likely to leave suture marks if not removed in days Apposition of the edges and eversion are more difficult to achieve with running sutures, and the entire suture line can unravel if the suture breaks anywhere along the repair However, the technique gives the advantage of having equal tension on the wound edges FIGURE 110.4 Simple interrupted skin suture secured with instrument tie