Multiple sutures
When multiple sutures are to be placed, the incision can be closed with running or continuous sutures. (A) The first papilla is closed and the knot tied the usual way. The long end of the suture is held, and the adjacent papilla is sutured without the knot being tied, but just with the suture being pulled firmly through tissue. (B) Succeeding papillae are then sutured until the final one is sutured and the final knot is tied. The final appearance is with the suture going across each empty socket. (C) A continuous locking suture can be made by passing the long end of the suture underneath the loop before it is pulled through tissue. (D) This puts the suture on the deep periosteal and mucosal surfaces directly across the papilla and may aid in more direct apposition of tissues.
