Intradermal Double-Layer Closure with Suture Knot Contained Within Incision: Easy, Fast, and Safe

Abstract

We read with great interest the recent article by Thomas C. Wiener [1]. About 12 years ago Maia introduced the intradermal double-layer closure technique with the suture knot contained within the incision. Since that time he has used it as his standard suture technique in more than 3000 cases that include different aesthetic surgery procedures. The technique consists of an intradermal double-layer closure with a deep and a superficial dermal running component that are in continuity (Figs. 1 and 2), with no intradermal orientation stitches (except in very large incisions, i.e., [40 cm). The final knot is placed deep within one end of the incision (Fig. 2). In our experience this technique is safe and fast and puts less artificial material inside the wound compared with conventional techniques that have internal knots and running suture. We reported very few cases of knot extrusion, which were probably caused by a superficial position of the knot, and there were no major consequences. Because of the results we have with our technique we do not see any significant advantage of the remote-knot technique, which has the disadvantage of a second scar, even if it is a small scar. Reference

Regarding the Remote-Knot Technique

“…Maia and Azevedo letter [1] about in my article [2]. Overall, I would agree with their analysis that the remote-knot technique may not hold any advantage in many types of plastic surgery incision closures.…”