parallel to the defect edge. The horizontal mattress stitches, as opposed to simple interrupted stitches, facilitate excellent wound edge eversion without the need for buried sutures. The tape, being directly adjacent to the defect edge, prevents edges from rolling inward. Sutures and tape are removed together approximately 14 days postoperatively (Figures 1-4).
After cleansing the surgical site with alcohol, use a gentian violet marker to draw an ellipse, with appropriate margins, around the lesion to be excised. Anesthetize as usual, then prepare the site with povidone-iodine, which dries without any slippery residue. Wipe the skin directly adjacent and lateral to the marked ellipse with liquid adhesive before placing four long surgical strips directly adjacent and lateral to the drawn ellipse, forming a diamond pattern with the tape. Excise the lesion along the drawn ellipse, right at the tape’s edge. Begin the closure midway along the defect by placing the initial horizontal mattress stitch through the tape and skin beneath. Then place additional horizontal mattress stitches one quarter of the way from each end of the ellipse. Alternatively, in very long or wide defects, especially those under tension, begin the closure by placing the rst horizontal mattress stitch one quarter of the way from one end of the ellipse, the second one one quarter of the way from the opposite end of the ellipse, and a third one midway along the ellipse. Place additional horizontal mattress stitches, as needed, along the length of the defect until all defect edges are directly apposed and everted. One to two weeks postoperatively, depending on the location of the surgical site, remove the horizontal mattress stitches in the usual fashion before lifting the tape off the skin surface.
The tape buttress technique to repair surgical defects on atrophic skin is a secure and effective way to appose and evert atrophic defect edges. The tape acts as a buttress to reinforce the atrophic skin so that suture does not tear through it and defect edges do not roll. Horizontal mattress stitches are used to evert defect edges and ensure good wound healing. Sutures and tape should be removed one to two weeks postoperatively for optimal cosmesis.
The author has no conflict of interest.
- Zitelli JA, Moy RL. Buried Vertical Mattress Suture. J Dermatol Surg Oncol. 1989;15:17-19
- Yag-Howard C. Novel Approach to Subcutaneous Closure:The Subcutaneous Inverted Cross Mattress Stitch (SICM Stitch). Dermatol Surg 2011;37:1503-5
- Davis M, Nakhdjevani A, Lidder S. Suture/steri-strip combination for the management of lacerations in thin-skinned individuals. J Emerg Med
- Lin M. Trick of the trade: steri-strip suture combo for thin skin lacerations. Academic Life in Emergency Medicine, March 30, 2011. http://academiclifeinem.com/trick-of-the-trade-steristrip-suture-combo. Accessed September 19, 2015.
Cyndi Yag-Howard MD FAAD firstname.lastname@example.org