Placement of “Guiding Sutures” to Counteract Undesirable Retraction of Tissues in and Around Functionally and Cosmetically Important Structures

Repair of Lateral Sidewall and Partial Alar Defects: Nasalis Island Pedicle Flap with Partial Second-Intention Healing

“…We have found that guiding suture placement over the remaining alar defect obviates rim distortion. It is possible that flap advancement itself would result in no free margin retraction, even without a retention suture, although there is evidence that placement of guiding sutures across opposite edges of a wound will serve to control the direction of wound contraction and obviate unwanted free margin distortion 10,11 …”

Minimally Invasive Options for Cutaneous Defects: Secondary Intention Healing, Partial Closure, and Skin Grafts

“…Ectropion, eclabium, and alar flaring or collapse may result. Strategically positioned guiding sutures can be used in these and other locations to redirect the natural tension vectors and minimize or prevent such complications [62]. The sutures are placed across the wound in a direction perpendicular to that of the contraction vector to be eliminated.…”

“…Placement must be delayed after tumor ablation with cryosurgery or electrosurgery, because these modalities result in peripheral tissue necrosis and sloughing. Albright recommends a lag time after cryosurgery and electrosurgery of 20 to 26 days and 14 days, respectively [62]. As wounds heal with guiding sutures in place, tension vectors will adjust accordingly.…”

Cheek Advancement Flap with Retained Standing Cone for Reconstruction of a Defect Involving the Upper Lip, Nasal Sill, Alar Insertion, and Medial Cheek

“…4,5 Additional natural boundaries include the vermilion border and nasal base junction. 6,7 Both these options were ruled out due to the large size of the defect and potential for eclabium with second intention healing. 1 Primary closure along a vertical axis is perhaps the most desired reconstruction when it can be performed.…”