Practical Plastic Surgery for Nonsurgeons

16 Practical Plastic Surgery for Nonsurgeons
2. Cut one strand of the suture under the knot.
3. Remove the entire stitch by grabbing the knot with a clamp or forceps
and pulling gently. This suture will be a little harder to remove
than a simple suture.
4. If you accidentally cut both ends of the suture, you will leave suture
material behind.
5. Look on the opposite side of the skin for the suture. Grab it with a
clamp or forceps, and gently remove the remaining suture material.
Continuous Sutures
1. Cut the suture in several places where it is exposed, crossing the
wound edges.
2. Remove portions of the stitch by grabbing an end with a clamp or
forceps and pulling gently.
3. The sutures to the knot must be cut in several places for removal.
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Other techniques can bring skin edges together to “suture” a wound
closed without using sutures. These techniques require more expensive
equipment than regular suturing.
Skin Stapler
Indication. The skin stapler is a medical device that places metal staples
across the skin edges to bring the skin together. The area must be
anesthetized before placing the staples. The main advantage of staples
over sutures is that they can be placed quickly. Speed may be an important
advantage when you need to close a bleeding wound quickly
(e.g., on the scalp) to decrease blood loss. Staples tend to leave more
noticeable marks in the skin compared with sutures. They should not
be used on the face.
Technique
1. The edges must be everted. Usually an assistant must help by using
forceps to hold the skin edges so that the dermis on each side
touches.
2. Place the center of the stapler (usually an arrow on the stapler marks
the center) at the point where the skin edges come together.
3. Gently touch the stapler to the skin; you do not have to push it into
the skin. Then grasp the handle to compress it; the compression releases
the staple.