Surgical pearl: percutaneous buried vertical mattress for the closure of narrow wounds

The Origin and Development of Interrupted Subcuticular Suture: An Important Technique for Achieving Optimum Wound Closure

BACKGROUND

Subcuticular suture is an important technique for achieving optimum wound closure, and there has been no comprehensive summary of subcuticular sutures to date.

OBJECTIVE

To summarize the origin and development of interrupted subcuticular suture to help clinicians improve their wound closure skills.

MATERIALS AND METHODS

A comprehensive review of subcuticular suture techniques was conducted in PubMed to summarize the advantages and disadvantages of various methods and clinical indications.

RESULTS

Buried suture is the oldest subcuticular suture technique, followed by buried vertical mattress suture, intracutaneous butterfly suture, modified/variant buried vertical mattress suture, intradermal buried vertical mattress suture, buried horizontal mattress suture, wedge-section and modified buried vertical mattress suture, set-back suture, and modified buried horizontal mattress suture, which have gradually been applied in clinical practice. Buried vertical mattress suture is currently the most widely used subcuticular suture technique.

CONCLUSION

Patients can certainly benefit from the appropriate application of subcuticular suture. There is also no single ideal method for achieving optimal results in all cases. Fully understanding the history of subcuticular suture can help doctors improve their wound closure technique.

Dermatologic Surgical Pearls: Enhancing the Efficacy of the Traditional Elliptical Excision

Dermatologic surgery procedures can sometimes be time consuming in an office setting. We present a series of tips for dermatologists and dermatologic surgeons that will enhance the efficiency of simple procedures.

Sutures, needles, and tissue adhesives: a review for dermatologic surgery

BACKGROUND

Dermatologic surgery generally requires the removal of offending or excessive tissue followed by repair of the resultant defect. The functional and cosmetic outcome is increasingly important as patients' expectations grow and physicians become increasingly aware of surgical materials and techniques that enable them to repair defects in a functionally and cosmetically appealing manner.

OBJECTIVE

To perform an updated and thorough review of the literature regarding sutures, surgical tape, tissue adhesives and stitching techniques.

MATERIALS AND METHODS

A comprehensive literature review was conducted on-line via multiple search engines and sites using the keywords suture, suture techniques, suturing techniques, surgical techniques, surgical tapes, surgical adhesives, and tissue adhesives.

RESULTS

There are numerous articles on sutures, surgical tape, and tissue adhesives, but there are no current articles that review them together in a comprehensive manner and combine the review with a discussion of stitching techniques.

CONCLUSION

Suture choice and surgical and stitching techniques may be guided by the TAFT concept of wound closure that recognizes the main function of suture and closure devices: Tension relief; Apposition enhancement; and surface Finishing Touches. The dermatologist's goal is to create functionally and aesthetically pleasing scars for optimal patient satisfaction, which is of ultimate importance considering that the scars patients receive leave a lasting impression of their dermatology experience.

Wedge-shaped excision and modified vertical mattress suture fully buried in a multilayered and tensioned wound closure

BACKGROUND

A successful deep multilayered wound suture should provide a firm tension-relieving closure, good wound-edge eversion, hemostasis, and minimal intradermal extraneous materials. However, this is not always achieved with a single standard technique. The authors describe their modification of a wound closure method that can rapidly and reliably achieve these results.

METHODS

A wedge-shaped excision was adopted to obtain a trapezoid pattern transect, after which a modified fully buried vertical mattress suture technique was used to close the wound. These techniques were compared with the standard excision and suture techniques used for the same patient at different times after surgery.

RESULTS

The wedge-shaped excision can facilitate good wound-edge eversion, and the modified fully buried vertical mattress suture can provide firm tension relief and optimal apposition. Compared with conventional excision and suture techniques, the described techniques brought about a better outcome in terms of hypertrophic scar prevention.

CONCLUSION

The described modified technique seems to be more efficient than conventional procedures used to prevent hypertrophic scar formation.

Techniques for cutaneous sutured closures: variants and indications

Many different suture techniques are routinely used by cutaneous surgeons for the closure of surgical wounds. This paper reviews several common suture techniques and their associated subtypes. In particular, for each technique, we discuss the method for placement, generally accepted indications, controversies regarding utility, and objective evidence of efficacy.

Utility of fully buried horizontal mattress sutures

BACKGROUND

Deep absorbable stitches should provide a firm closure, hemostasis, and good wound-edge eversion, but this is not always achieved with standard techniques.

OBJECTIVE

We sought to investigate alternative techniques that can rapidly and reliably achieve these results.

METHODS

We evaluated the fully buried horizontal mattress suture. We compared this technique with the previously described fully buried vertical mattress, partially buried mattresses, and standard reticular dermal and subcutaneous sutures.

RESULTS

The fully buried horizontal mattress can provide excellent wound-edge approximation and eversion. It is particularly useful for shallow defects and narrow spaces where a deep stitch is required but technically difficult to insert. Overall, this method offers excellent final cosmesis, and individual sutures can be quickly and reproducibly placed with minimal practice. For very deep defects that require dead-space closure, the fully buried vertical mattress may be preferable.

CONCLUSIONS

The buried horizontal mattress suture has wide applicability as the buried stitch in a bilayer repair.