As a method of closing cutaneous wounds, the technique of suturing is thousands of years old. Although suture materials and aspects of the techniques changed, the goals remain the same: closing dead pace, supporting and strengthening wounds until healing increases their tensile strength, approximating skin edges for an aesthetically pleasing and functional result, and minimizing the risks of bleeding and infection.
Proper suturing is needed to ensure good results in dermatologic surgery. The post-operative appearance of a beautifully designed closure or flap can be compromised if an incorrect suture technique is chosen and or if the execution is poor. Poor incision placement with respect to relaxed skin tension lines, excessive removal of tissue, or inadequate undermining may limit the surgeon’s option in wound closure and suture placement. Gentle handling of the tissue is also important to optimize healing.
The choice of suture technique depends on the type and anatomic location of the wound, the thickness of the skin, the degree of tension, the desired cosmetic result. The proper placement of sutures enhances the precise approximation of the wound edges, which helps minimize and redistribute skin tension. Wound eversion is essential to maximize the risk of scar depression secondary tissue contraction during healing. Usually, inversion is not desirable and it is probably does not decrease the risk of hypertrophic scarring in an individual with a propensity of hypertropic scars. The elimination of dead space, the restoration of natural anatomic contours and the minimization of suture marks are also important to optimize the cosmetic and functional results.
In this course, the suture techniques used is reviewed, the techniques of suture placement for each type of technique is described, the rationale for choosing the type of suture are reviewed including the advantages and disadvantages of each suture technique. After taking this course, the student should have a clear understanding of how and why particular sutures are chosen and an appreciation of the basic methods of placing each type of sutures.