ABSTRACT
The proper selection of a suture placement method is of special importance when closing wounds under tension. If an inappropriate closure is used, scar widening, suture track marks, wound infection, or dehiscence may result. Additionally, suture placement may be unnecessarily difficult. Various methods, alone or in combination, have been utilized for managing the closure of wounds under tension, including extensive soft tissue undermining of wound edges, the use of an assistant to support wound edge approximation manually while initial suture knots are secured (1), beginning closure at the poles of a fusiform wound where tension is the least followed by placement of successive sutures inward where tension is maximal (1), mattress sutures (2), near-far-far-near suture (3), and pulley suture (4,5).
