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Plastic Surgery Pearls for basic suturing: instruments & technique

Contributors: Kumar Patel, PA-C

Basic plastic surgery suturing techniques geared towards medical students and residents, including starting position, basic simple suture, deep dermal suture, vertical mattress, horizontal mattress and running subcuticular.

DOI: http://dx.doi.org/10.17797/udwdtpze6v

Suturing is the joining of tissue with �needle and thread� so that the tissue binds together and heals. Basic suturing techniques, starting position, basic simple suture, deep dermal suture, vertical mattress, horizontal mattress & running subcuticular. Key technical points emphasized in the video are linked to the principal of "First do no harm" - mindfulness of this principle as it pertains to needle position on the driver and how the needle enters the tissue will produce an optimal wound closure with minimal collateral tissue trauma.
Simple Suture: can be used in any situation where precise cosmesis is needed such as the face or an area of higher tension or potential infection where removing the suture after closure has little downside. Deep Dermal Sutures: Indicated in most full thickness wounds and offloads the epidermis; one of the keys to a 'plastics closure' Horizontal & Vertical Mattress: utilized mainly on the trunk, scalp & extremities for areas of higher tension and where optimal tissue eversion is desired. These are not typically used for facial lacerations nor wounds. Running Subcuticular: One of the most common skin closures in plastic surgery- though not typically in the face; can simultaneously close the dermal and epidermal layers without the drawback of potential track marks. closing a laceration closing post excision of tissue, closing dead space, closing a bleeding vessel.
dirty, contaminated or acutely infected wound
Sterile field, gather instruments, gather type of suture for the specific repair
skin type and local tissue conditions must be carefully evaluated to achieve a durable and tension-free closure as possible.
the epidermal/ dermal junction is a key landmark for deep dermal sutures and running subcuticular sutures.
Choice of suture and technique may depend on the 1) the local wound characteristics 2) surgeon preference and comfort level 3) patient preference and compliance as to removable sutures or not
inflammation of tissue, bleeding, inadequate wound healing, wound infection, spitting of sutures, wound dehiscence, abscess, seroma, epidermal inclusion cyst o
inflammation of tissue, bleeding, inadequate wound healing, wound infection, spitting of sutures, wound dehiscence, abscess, seroma, epidermal inclusion cyst o
Tammy Roberson
a. http://www.practicalplasticsurgery.org/docs/Practical_01.pdf

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