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Subject: Corner Suture
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Approximating the tip of a skin flap with the corresponding defect
Approximating corners of skin flaps when performing tissue rearrangements such as T-plasties, V-Y-plasties, and the centers of advancement flaps
As part of Burow’s triangle repairs, especially when suturing unequal length skin edges and when performing tissue rearrangements (such as rotation flaps, O-to-Z-plasties, and the ends of advancement flaps
Wounds best closed by other methods
Presence of cellulitis, bacteremia, or active infection
PITFALL: The needle should not go all the way through the skin into the subcuticular tissue, as is the case with most other suturing techniques. The path of the needle is directly into the dermis, at which level it will remain until it exits the skin before tying.
PEARL: This pass may be made with the flap in anatomical position and with the needle drivers in a vertical position. However, many providers find it helpful to gently elevate the tip between the sides of pickups (do not actually grab or apply pressure to the flap tip), placing the tip in a vertical position for this pass.
PITFALL: If the flap tip is grasped, the chances of tip necrosis are greatly elevated.
PEARL: Make sure the suture passes symmetrically through the tip for best results.
PITFALL: Be careful not to tie the suture too loosely because this will cause poor approximation of the wound edge.
PITFALL: Be careful not to tie the suture too tightly because this can cause bunching of the skin, over- or underriding of the flap tip, or an increased risk of scarring under the knot.
PEARL: Make sure the suture passes symmetrically in a smooth arc through all of the tips for best results.