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Suturing of fragile skin
Journal of Plastic, Reconstructive & Aesthetic Surgery (2009) 62, e637ee638
CORRESPONDENCE AND COMMUNICATION
Suturing of fragile skin Suturing of thin skin in elderly patients is often problematic; sutures typically ‘cheese-wire’ if under any tension. Before discounting primary closure, we suggest a technique that avoids tearing fragile skin. Adhesive strips are used on the edge of the wound to increase the strength of the skin, acting as a further layer on the skin surface.
Skin adhesive strips (Steri-Strips) are laid on the wound edges without tension as shown in Figure 1. Simple or mattress sutures (4/0 nylon) are then used to close the skin by suturing through the Steri-Strips and skin edge in one bite (Figure 2). Subsequently, the SteriStrips are allowed to lift off the wound at the time of suture removal. To date, we have not experienced any traction blistering. This is a simple, quick technique applicable to many situations that may, at first impression, be deemed to require an alternative method of wound closure.
Figure 1 e The fragile-skin technique used in a directly closed wound on an ankle, following the excision of a basal cell carcinoma.
Figure 2 e The fragile-skin technique used on a VeY advancement flap on the anterior lower leg following the excision of a basal cell carcinoma. 1748-6815/$ - see front matter ª 2009 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. doi:10.1016/j.bjps.2008.11.091
e638
Financial disclosure The authors have no financial interest in the materials or techniques described in this article. M.D. Pacifico R.P. Teixeira
Correspondence and communication M. Ritz The Melbourne Institute of Plastic Surgery, 253 Wattletree Road, Malvern, 3144 VIC, Australia E-mail address: [email protected]
CORRESPONDENCE AND COMMUNICATION
Suturing of fragile skin Suturing of thin skin in elderly patients is often problematic; sutures typically ‘cheese-wire’ if under any tension. Before discounting primary closure, we suggest a technique that avoids tearing fragile skin. Adhesive strips are used on the edge of the wound to increase the strength of the skin, acting as a further layer on the skin surface.
Skin adhesive strips (Steri-Strips) are laid on the wound edges without tension as shown in Figure 1. Simple or mattress sutures (4/0 nylon) are then used to close the skin by suturing through the Steri-Strips and skin edge in one bite (Figure 2). Subsequently, the SteriStrips are allowed to lift off the wound at the time of suture removal. To date, we have not experienced any traction blistering. This is a simple, quick technique applicable to many situations that may, at first impression, be deemed to require an alternative method of wound closure.
Figure 1 e The fragile-skin technique used in a directly closed wound on an ankle, following the excision of a basal cell carcinoma.
Figure 2 e The fragile-skin technique used on a VeY advancement flap on the anterior lower leg following the excision of a basal cell carcinoma. 1748-6815/$ - see front matter ª 2009 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. doi:10.1016/j.bjps.2008.11.091
e638
Financial disclosure The authors have no financial interest in the materials or techniques described in this article. M.D. Pacifico R.P. Teixeira
Correspondence and communication M. Ritz The Melbourne Institute of Plastic Surgery, 253 Wattletree Road, Malvern, 3144 VIC, Australia E-mail address: [email protected]