A Suture-Tightening Technic for Delayed Wound Closure Daniel J. AbCamson, MD, Washington, DC
Wire sutures are used primarily as retention sutures or for the secondary or delayed primary closure of wounds. Steel wire is inert to the tissues and can be tightened by twisting-the only such suture material available. The disadvantages lie in the difficulty in handling, tying, and cutting and in the tendency for wire to cut through the skin. Pain is caused by tightening of the suture and in its subsequent removal. When used beneath the skin surface, wire can unravel, break, or cause painful subcutaneous nodules. The purpose of this report is to describe a method of using standard suture material to supplant the use of wire for delayed wound closure or for the tightening of loosened stitches. The steps in the technic are as depicted in Figure 1. (A) The original suture had been tied loosely. The skin edges are not approximated. A pack can be inserted if necessary. (B) A second suture is tied around a loop of the first suture. Silk or cotton is preferred because of the ease in handling and the security of the knot. (C) The knot is twisted with a hemostat until the skin edges are brought into position. (D) The second suture is then tied securely about the base of the first twisted suture to fix and prevent the latter from unwinding. Summary Figure 1. Suture-Ughtening technic tor delayed wound closure.
From the Department of Surgery, Walter Reed Army Medical Center, Washington, DC. Reprint requests should be addressed to Daniel J. Abramson, MD, Department of Surgery, Walter Reed Army Medical Center, Washington, DC 20012.
A method is described that allows the tightening of standard suture materials for skin approximation of open wounds. The need for wire sutures in such circumstances is therefore unnecessary. The technic has been applied in delayed primary or secondary wound closure, and in the tightening of loosened ties or retention sutures.
The American Journal of Surgery