- Indications
-
Wound sites with wound edge inversion risk
- Posterior neck
- Concave skin surface
- Contraindications
-
Relative
- Areas at risk for scarring (e.g. face)
- Optimizes wound edge eversion
- Increased closure strength (distributes tension)
- Background
- Uses Far-far, near-near system
- Use non-Absorbable Suture
- Four landmark sites (2 on each side of the wound)
- Point 1 (Far right side): 4-8 mm from wound edge
- Point 2 (Near right side): 1-2 mm from wound edge
- Point 3 (Near left side): 1-2 mm from wound edge
- Point 4 (Far left side): 4-8 mm from wound edge
- Images

- Step 1: Far-Far Stitch
- Enter wound at Point 1 on far right side of wound
- Needle passes deep, below Dermis
- Exits at point 2 on far left side of wound
- Step 2: Near-Near Stitch
- Continue stitch started in Step 1
- Enter wound at point 3 on near left side of wound
- Exits at point 4 on near right side of wound
- Step 3: Tie Suture
- Knot is between point 2-3 on right side of wound
- Tie snugly, but avoid tying too tightly
- See complications below
- Step 4: Final appearance
- Suture exposed between point 3 and 4
- Suture exposed between point 1 and 2
-
Suture tied too tightly, excessive pulling
- Excessive wound eversion
- Wound scarring and railroad track wound appearance
- Skin necrosis where Suture exposed over skin
-
Sutures not placed to consistant depth or distance
- See Technique tips below
- Results in scar with irregular surface
- Irregular surface may be quite evident (esp. face)
- Technique tips (avoid complications)
- Do not place Sutures too tightly
- Choose smaller caliber Suture Material (e.g. 5-0)
- Remove Sutures early (by day 4-6 for most wounds)
- Leave non-mattress Sutures in to prevent dehiscence
- Place Sutures symmetrically
- Point 1-2 are the same distance from wound as 3-4
- All Point 1s line up along edge of wound
- Similarly, all Point 2s line up, Point 3s ...
- Asymmetric Suture placement results in irregular scar
- See Complications above
- Mortiere (1996) Wound Management, p. 50-5
- Snell in Pfenninger (1994), Mosby, p. 12-9
-
Zuber (2002) Am Fam Physician 66(12):2231-6 [PubMed]
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