When performing dermal sutures, we aim to achieve a satisfactory postoperative scar from an aesthetic perspective and reduce surgical site infection and other postoperative complications.1–3 Although the usefulness of dermal sutures is widely recognized, some residents and general surgeons are still reluctant to use dermal sutures due to concerns regarding the time needed to master this unfamiliar technique. Therefore, we designed a plotting dermal suture (PDS) method, which can be easily applied to appropriately perform dermal suturing. With this technique, we believe that even inexperienced surgeons can make dermal sutures in a quick and easy manner.
Before dermal suturing, the wound edges should be approximated through subcuticular closure, depending on the skin condition surrounding the incision or wound.
In the present report, we describe the use of this method for the closure of an incision on the abdominal wall. First, we mark dots on the skin representing the target dermal suture points (Fig. 1); we usually mark these dots 10 mm from the wound edge with an interval of 15 mm between dots. Generally, we use 4-0 absorbable sutures, and in certain cases requiring high tension, we use 3-0 absorbable sutures.
The suturing technique is similar to the classic dermal suturing technique. The needle is inserted vertically from the fat layer to just below the dot, screwing the needle into the reticular dermis and advancing it to the epidermis. The needle is then extracted and reinserted in the contralateral side of the wound edge at the same dermal level and advanced to just below the dot, screwing the needle into the reticular dermis and advancing to the epidermis. Thus, by marking the dots before performing the dermal suture, they can be easily followed for effective wound closure (Fig. 2).
Needle handling is generally easy for plastic surgeons who practice dermal sutures daily. However, it may be difficult for residents and general surgeons who do not routinely use this type of suture. Therefore, we developed an easier method of performing this technique.
The advantages of this method are as follows: 1) after marking the dots, only the dot position at the level of the fatty layer for insertion and extraction of the needle needs to be focused on; 2) by marking the dots before initiating the procedure, the appropriate intervals can easily be ensured during suturing, and it is thus less time consuming; and 3) the wound margin rises up symmetrically, which provides better approximation of the wound edges, thus promoting wound healing and resulting in less scarring. We currently conduct a hands-on seminar of the PDS method to residents and general surgeons and have observed better outcomes in both groups after practicing our proposed method.
By applying our PDS methods, we believe that all surgeons, with or without clinical experience, can master the dermal suture technique in a short time period. Thus, we recommend the use of the novel PDS method for easy, quick, and effective wound closure.
The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.
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2. Johnson RG, Cohn WE, Thurer RL, et al. Cutaneous closure after cardiac operations: a controlled, randomized, prospective comparison of intradermal versus staple closures. Ann Surg. 1997;226:606–612
3. Shetty AA, Kumar VS, Morgan-Hough C, et al. Comparing wound complication rates following closure of hip wounds with metallic skin staples or subcuticular vicryl suture: a prospective randomized trial. J Orthop Surg. 2004;12:191–193