You see a patient with a large V-shaped laceration under tension requiring suture repair. Resist the temptation to simply pull the edges together and close the laceration with simple interrupted or running sutures. Excessive tension on a flap edge during the healing process can compromise its blood supply. This causes ischemia to the healing tissue, which in turn makes that flap edge more likely to dehisce, necrose, and become infected.
Trick of the Trade:
Laceration repair using V-to-Y flap technique
Consider reducing the wound tension by converting the V-flap in to a Y-shaped flap using a carefully placed half-buried horizontal mattress suture (also known as a corner suture). An extra few minutes spent planning this closure will facilitate easier immediate closure and create a better long term outcome for your patient.
Video from Dr. Brian Lin’s website (LacerationRepair.com)
For a more detailed diagrammatic explanation of this technique, visit the full blog post at my site.
Want to hear more from Dr. Brian Lin?
Brian will be one of the featured speakers at the 2015 High Risk Emergency Medicine Conference in Hawaii. There he will be talking about not only Advanced Laceration Management but also Abdominal Vascular Emergencies, Burns, and Eye Emergencies!
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