Abstract
Surgical outcomes in cutaneous surgery are impacted by preoperative design, excision, and repair. Optimal suturing technique plays an important role in skin repairs and is achieved through appropriate selection of suture material and needle points, gentle handling of the tissue, and properly placed sutures. This review addresses the above key principles, strategies for correct knot tying, and situations where special sutures may promote a better outcome.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Sobanko JF, Sarwer DB, Zvargulis Z, Miller CJ. Importance of physical appearance in patients with skin cancer. Dermatol Surg. 2015;41:183–8. Literature review looking at the psychosocial effects of patients after cutaneous surgery. Conclusions include the use of validated patient-reported outcome tools in place of objective scar assessment tools to predict patients at risk for psychosocial impairment following cutaneous surgery.
Dixon AJ, Dixon MP, Dixon JB. Prospective study of long-term patient perceptions of their skin cancer surgery. J Am Acad Dermatol. 2007;57:445–53.
Miller CJ, Antunes MB, Sobanko JF. Surgical technique for optimal outcomes: part I. Cutting tissue: incising, excising, and undermining. J Am Acad Dermatol. 2015;72:377–87. This article provides a stepwise approach to incising, excising, and undermining in cutaneous surgery. The authors take a checkpoint-based approach that focuses on specific objective quality control points that should be met to ensure good outcomes.
Sobanko JF, M.C.J. 2015. The elliptical excision and its variations in procedural dermatology. New York, NY: McGraw-Hill: New York, NY.
Miller CJ, Antunes MB, Sobanko JF. Surgical technique for optimal outcomes: part II. Repairing tissue: suturing. J Am Acad Dermatol. 2015;72:389–402. Part 2 of the above article that uses the checkpoint-based approach to optimize suturing in cutaneous surgery. It provides diagrams to explain the cause of the various suturing outcomes. The checkpoint approach ensures that mistakes are not compounded throughout the suturing process.
Robinson JK, Hanke W, Siegel D, Fratila A, Bhatia A, Rohrer T. Surgery of the skin: procedural dermatology. 3rd ed. New York: Elsevier Saunders; 2014.
Bolognia J, Jorizzo JL, Schaffer JV. 2012. Dermatology. [Philadelphia]; London: Elsevier Saunders. 1 online resource (2 v. in 1).
Herrmann JB. Tensile strength and knot security of surgical suture materials. Am Surg. 1971;37:209–17.
Burkhart SS, Wirth MA, Simonick M, Salem D, Lanctot D, Athanasiou K. Loop security as a determinant of tissue fixation security. Arthroscopy. 1998;14:773–6.
Zitelli JA, Moy RL. Buried vertical mattress suture. J Dermatol Surg Oncol. 1989;15:17–9.
Kantor J. The set-back buried dermal suture: an alternative to the buried vertical mattress for layered wound closure. J Am Acad Dermatol. 2010;62:351–3.
Wang AS, Kleinerman R, Armstrong AW, Fitzmaurice S, Pascucci A, Awasthi S, Ratnarathorn M, Sivamani R, King TH, Eisen DB. 2015. Set-back versus buried vertical mattress suturing: results of a randomized blinded trial. J Am Acad Dermatol 72:674–680. A split wound randomized control trial comparing the set-back and buried vertical mattress sutures. Results suggested that the set-back suture provided increased eversion and better patient-reported outcomes compared to the buried vertical mattress suture.
Kantor J. The fascial plication suture: an adjunct to layered wound closure. Arch Dermatol. 2009;145:1454–6.
Desciak EB, Eliezri YD. Surgical pearl: temporary suspension suture (Frost suture) to help prevent ectropion after infraorbital reconstruction. J Am Acad Dermatol. 2003;49:1107–8.
Davis JC, Baillis B, Love WE. Novel stacked double purse-string closure. Dermatol Surg. 2014;40:1409–12.
Giandoni MB, Grabski WJ. Surgical pearl: the dermal buried pulley suture. J Am Acad Dermatol. 1994;30:1012–3.
Yag-Howard C. Novel surgical approach to subcutaneous closure: the subcutaneous inverted cross mattress stitch (SICM Stitch). Dermatol Surg. 2011;37:1503–5.
Albertini JG. The criss-cross tie-over tacking suture. Dermatol Surg. 2002;28:188–9.
Finley EM. The crisscross tie-over tacking suture revisited. Dermatol Surg. 2003;29:281–3.
Moody BR, McCarthy JE, Linder J, Hruza GJ. Enhanced cosmetic outcome with running horizontal mattress sutures. Dermatol Surg. 2005;31:1313–6.
Kandel EF, Bennett RG. The effect of stitch type on flap tip blood flow. J Am Acad Dermatol. 2001;44:265–72.
Compliance with Ethics Guidelines
Conflict of Interest
Matthew R. LeBoeuf, Christopher J. Miller, and Joseph F. Sobanko declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Author information
Authors and Affiliations
Corresponding author
Additional information
This article is part of the Topical Collection on Medical Surgery
Rights and permissions
About this article
Cite this article
LeBoeuf, M.R., Miller, C.J. & Sobanko, J.F. Suturing Techniques for Optimal Surgical Outcomes. Curr Derm Rep 4, 105–112 (2015). https://doi.org/10.1007/s13671-015-0107-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13671-015-0107-4