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This technique is usually applied to simple wounds both traumatic and surgical following excision of a skin lesion for example.

The needle is placed perpendicular to the wound on the opposite side approximately 3-5mms away (depending on the size and position of the wound) from the wound edge. The needle is passed preferably in a way that it produces a pathway, which is wider at the base of the wound than at its surface (figure 17). The proximal side is dealt with a reverse fashion. This will result in a 'brandy' glass shape to the suture pathway (figure 18). When the wound is approximated, eversion will occur.

Figure 17: Demonstrates that equal bites are taken on either side of the wound. (The depth of the bites is also equal).

Figure 18: The bowl of the brandy glass mimics the shape of the suture i.e. the surface aspect is narrower than the base.

It is important to ensure that the width and depth of the 'bites" are similar on both sides to prevent and overlap of the wound edges. Small bites will produce precise approximation of small wounds whereas larger bites are useful for eliminating dead space and for reducing tension in larger wounds (preventing ischaemia of the wound edges).

The interval between sutures will vary with particular wound. Too many sutures will lead to ischaemia; too little may lead to a poorly approximated wound.

Continuous suturing instead of placing individual simple sutures is an alternative method. However in day-to-day closure of simple wounds, it is rarely used. It can produce ugly crosshatch marks and it may be difficult in making fine adjustments.