Videos of Surgical Procedures in Dermatology
Subcutaneous Vector-Running Sutures
Sutura oblicua subcutánea
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The same case is presented in the video.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The results of the surgical excision of tumors situated in areas of skin tension, especially on the back and thighs, are often poor. Wound dehiscence can occur in the immediate postoperative period, and scar dehiscence almost always occurs in the long term. To avoid these complications, suture removal is often delayed, but this frequently leaves suture marks along the borders of a scar in which dehiscence has occurred, giving rise to a typical “crab-like” appearance (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). However, if the sutures are removed too early, wound dehiscence is possible.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">In 1992, Weber and Wulc<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> described the <span class="elsevierStyleItalic">vector-running suture</span> for the closure of wounds situated in areas of tension in order to avoid dehiscence; when tension occurs across the borders, these sutures tend to further approximate the borders instead of allowing them to separate. Soon after that paper was published, we were regularly using these sutures to close skin defects on the back, but although the results were better than with traditional techniques, they were not always satisfactory.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Other proposed techniques can effectively prevent wound dehiscence, but subsequent scar dehiscence remains a possibility, as absorbable sutures dissolve within a period that varies between 10 and 30 days.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">To avoid scar dehiscence in the long term, we use a well-tolerated, nonabsorbable suture material that does not deteriorate over time. This ensures that wound tension is controlled and dehiscence avoided in the short term and that an imperceptible scar is achieved in the long term. We decided to place the vector-running suture entirely subcutaneously in order to leave no visible points of entry or exit.</p><p id="par0025" class="elsevierStylePara elsevierViewall">At the 2005 CILAD conference,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> we presented a personal technique that resolved the problem of dehiscence and, since that time, we have used this technique regularly in suitable cases.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Surgical technique</span><p id="par0030" class="elsevierStylePara elsevierViewall">After excision of a tumor, and in accordance with the general principles of dermatologic surgery, we initiate closure of the resulting defect. We first suture the deep plane with a 3/0 or 4/0 braided, multifilament, absorbable, polyglycolic acid suture (Vicryl, Ethicon). We then perform the vector-running suture subcutaneously (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). We start the suture at the midpoint of one of the borders of the wound (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). The curved needle is inserted into the mid-to-deep dermis and, using a circular movement, it is exteriorized as close as possible to one end of the wound (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). From here (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C), we enter the opposite border of the wound to start a normal subcutaneous suture (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>D), which we continue until we reach the opposite end of the wound (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>E). From the most distal extreme of the opposite lip of the wound to where the suture was started, we introduce the needle so as to exit just opposite to the initial point of entry and we tie it with the opposite side to approximate the 2 borders (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>F). In this way, when tension develops in the wound borders, the pulley design of the suture draws the borders closer together, avoiding dehiscence.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">We initially employed Gore-Tex as the suture material, based on our experience accumulated over many years with the use of these sutures as filler material in cosmetic dermatology.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In recent years we have changed to Ti-cron (Tyco-Healthcare Spain, SL), a nonabsorbable, silicone-coated braided polyester suture uniformly, which has shown excellent tolerance in cardiac and ophthalmologic surgery.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0040" class="elsevierStylePara elsevierViewall">The main indication for this technique is primary closure of skin defects in areas subject to movement, particularly on the back and limbs. The tension that can develop in the borders of such wound or scar could provoke dehiscence.</p><p id="par0045" class="elsevierStylePara elsevierViewall">As in all primary closures, wide dissection of the borders is necessary to avoid tension during suturing.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Complications</span><p id="par0050" class="elsevierStylePara elsevierViewall">The complications associated with any surgical technique can occur. Tolerance to the suture material we use is excellent. We have had no complications.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="par0055" class="elsevierStylePara elsevierViewall">The technique we have described is a simple way to prevent dehiscence of a wound or of the subsequent scar in areas of skin under tension (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Surgical technique" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Indications" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Complications" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of Interest" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Serrano-Ortega S, Serrano-Falcón C, Fernández-Pugnaire M. Sutura oblicua subcutánea. Actas Dermosifiliogr. 2015;106:71–73.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0070" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0040" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 571 "Ancho" => 1501 "Tamanyo" => 90011 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Suture marks in the borders of a scar. B, In the long term, these marks are often associated with dehiscence.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 963 "Ancho" => 1500 "Tamanyo" => 307862 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Surgical technique. See the description in the text.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 713 "Ancho" => 950 "Tamanyo" => 115093 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Scar from the excision of a melanoma on the anterior aspect of the right thigh 2 years after performing the vector-running subcutaneous suture. The same case is presented in the video.</p>" ] ] 3 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 77748599 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vector-running sutures in high-tensions and high-mobility areas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.J. Weber" 1 => "A.E. 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Monheit" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mjd.2001.110392" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2001" "volumen" => "44" "paginaInicial" => "114" "paginaFinal" => "116" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11148487" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sutura oblicua subcutánea. Libro de resúmenes XVI Congreso CILAD" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Serrano Falcón" 1 => "S. Serrano Ortega" 2 => "J. Abad" 3 => "J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 13 | 4 | 17 |
| 2024 October | 91 | 46 | 137 |
| 2024 September | 136 | 38 | 174 |
| 2024 August | 168 | 62 | 230 |
| 2024 July | 130 | 35 | 165 |
| 2024 June | 108 | 36 | 144 |
| 2024 May | 116 | 41 | 157 |
| 2024 April | 99 | 27 | 126 |
| 2024 March | 92 | 36 | 128 |
| 2024 February | 90 | 35 | 125 |
| 2024 January | 90 | 34 | 124 |
| 2023 December | 108 | 16 | 124 |
| 2023 November | 118 | 31 | 149 |
| 2023 October | 175 | 21 | 196 |
| 2023 September | 200 | 25 | 225 |
| 2023 August | 123 | 17 | 140 |
| 2023 July | 143 | 36 | 179 |
| 2023 June | 100 | 27 | 127 |
| 2023 May | 128 | 29 | 157 |
| 2023 April | 124 | 26 | 150 |
| 2023 March | 132 | 26 | 158 |
| 2023 February | 105 | 21 | 126 |
| 2023 January | 100 | 27 | 127 |
| 2022 December | 95 | 34 | 129 |
| 2022 November | 74 | 31 | 105 |
| 2022 October | 62 | 21 | 83 |
| 2022 September | 83 | 46 | 129 |
| 2022 August | 59 | 33 | 92 |
| 2022 July | 54 | 40 | 94 |
| 2022 June | 34 | 29 | 63 |
| 2022 May | 118 | 32 | 150 |
| 2022 April | 107 | 27 | 134 |
| 2022 March | 97 | 33 | 130 |
| 2022 February | 87 | 20 | 107 |
| 2022 January | 120 | 35 | 155 |
| 2021 December | 90 | 42 | 132 |
| 2021 November | 57 | 40 | 97 |
| 2021 October | 74 | 49 | 123 |
| 2021 September | 78 | 34 | 112 |
| 2021 August | 52 | 24 | 76 |
| 2021 July | 57 | 29 | 86 |
| 2021 June | 48 | 31 | 79 |
| 2021 May | 61 | 29 | 90 |
| 2021 April | 122 | 42 | 164 |
| 2021 March | 109 | 21 | 130 |
| 2021 February | 64 | 23 | 87 |
| 2021 January | 58 | 21 | 79 |
| 2020 December | 54 | 13 | 67 |
| 2020 November | 26 | 13 | 39 |
| 2020 October | 34 | 11 | 45 |
| 2020 September | 25 | 11 | 36 |
| 2020 August | 26 | 21 | 47 |
| 2020 July | 32 | 5 | 37 |
| 2020 June | 34 | 22 | 56 |
| 2020 May | 35 | 18 | 53 |
| 2020 April | 38 | 13 | 51 |
| 2020 March | 37 | 18 | 55 |
| 2020 February | 5 | 1 | 6 |
| 2020 January | 4 | 1 | 5 |
| 2019 December | 8 | 3 | 11 |
| 2019 November | 4 | 0 | 4 |
| 2019 September | 10 | 1 | 11 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 2 | 12 | 14 |
| 2019 June | 4 | 19 | 23 |
| 2019 May | 4 | 26 | 30 |
| 2019 April | 1 | 21 | 22 |
| 2019 March | 0 | 5 | 5 |
| 2019 February | 2 | 2 | 4 |
| 2019 January | 0 | 2 | 2 |
| 2018 December | 4 | 9 | 13 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 4 | 0 | 4 |
| 2018 September | 7 | 0 | 7 |
| 2018 June | 0 | 2 | 2 |
| 2018 May | 0 | 9 | 9 |
| 2018 April | 1 | 5 | 6 |
| 2018 March | 0 | 1 | 1 |
| 2018 February | 52 | 4 | 56 |
| 2018 January | 67 | 5 | 72 |
| 2017 December | 61 | 7 | 68 |
| 2017 November | 48 | 5 | 53 |
| 2017 October | 47 | 8 | 55 |
| 2017 September | 37 | 7 | 44 |
| 2017 August | 43 | 12 | 55 |
| 2017 July | 51 | 7 | 58 |
| 2017 June | 86 | 24 | 110 |
| 2017 May | 59 | 25 | 84 |
| 2017 April | 53 | 20 | 73 |
| 2017 March | 31 | 47 | 78 |
| 2017 February | 30 | 19 | 49 |
| 2017 January | 30 | 15 | 45 |
| 2016 December | 57 | 18 | 75 |
| 2016 November | 64 | 15 | 79 |
| 2016 October | 46 | 21 | 67 |
| 2016 September | 0 | 1 | 1 |
| 2016 August | 0 | 3 | 3 |
| 2016 July | 9 | 1 | 10 |
| 2016 June | 23 | 1 | 24 |
| 2016 May | 15 | 17 | 32 |
| 2016 April | 11 | 1 | 12 |
| 2016 March | 9 | 10 | 19 |
| 2016 February | 3 | 12 | 15 |
| 2016 January | 4 | 22 | 26 |
| 2015 December | 9 | 14 | 23 |
| 2015 November | 12 | 18 | 30 |
| 2015 October | 13 | 19 | 32 |
| 2015 September | 7 | 9 | 16 |
| 2015 August | 9 | 3 | 12 |
| 2015 July | 85 | 10 | 95 |
| 2015 June | 30 | 7 | 37 |
| 2015 May | 53 | 24 | 77 |
| 2015 April | 67 | 13 | 80 |
| 2015 March | 61 | 19 | 80 |
| 2015 February | 7 | 2 | 9 |
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