A modified corner-stitch for V-laceration repair

Abstract

Objective: To propose two modified variations of a corner horizontal mattress stitch to secure V-pattern lacerations with large epidermal corners that does not compromise flap blood supply. Methods:The flap criteria for utilization of this technique included a large superficial epidermal corner and physician judgment that a dermal stitch placed using the classic horizontal mattress corner stitch method would be ineffective in securing the flap corner. The modified corner horizontal mattress stitch suturing technique was developed and applied in practice to a patient presenting with a V-laceration requiring repair. The corner flap generated by the laceration contained an epidermal area too large to secure with an adjacent dermal stitch alone. Further studies using cadaveric non-human skin were used to validate the effectiveness of this and a similar technique in securing V-laceration simulations. Result:The modified corner horizontal mattress stitch technique was applied to secure a V-laceration corner using a dermal stitch and overlying skin tension sutures. There was no evidence of flap ischemia on follow-up at 14 days and acceptable cosmesis was achieved per patient report. No complications resulted from this technique. Further studies in non-human models demonstrated the effectiveness of this and a similar technique in repairing V lacerations with large epidermal corners. Conclusion:We present two modified corner horizontal mattress stitches that are effective in securing V-lacerations with large epidermal corners and a tenuous blood supply.