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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">A number of recent publications have described various surgical techniques to prevent wound dehiscence in the immediate postoperative period and later scar dehiscence&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> The main objective in dermatologic surgery is to achieve complete excision of a tumor followed by the best possible functional and cosmetic outcome&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">At the 2005 Iberian&#8211;Latin American Dermatology Conference &#40;CILAD&#41;&#44; Serrano Falc&#243;n et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> presented a new surgical technique&#44; the vector-running subcutaneous suture&#44; improving on the technique proposed by Weber and Wulc<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> to prevent wound and scar dehiscence&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The technique we currently use in our center to prevent wound and scar dehiscence is the continuous suture by tissue planes&#46; This consists of a continuous subcutaneous suture followed by an intradermal suture&#59; it is an adaptable and simple technique that enables us to control tension forces in the wound until this has healed&#46; Furthermore&#44; the use of an intradermal suture avoids the unsightly marks left by external stitches and makes further attendance for suture removal unnecessary&#46; We use an absorbable suture material with a mid-term absorption time to avoid the formation of foreign body granulomas that can develop when nonabsorbable sutures are used&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Description of the Technique</span><p id="par0020" class="elsevierStylePara elsevierViewall">For the continuous suture we use 3&#47;0 Novosyn&#44; a coated&#44; braided synthetic suture of poly&#40;glycolide-co-l-lactid 90&#47;10&#41; with a mid-term absorption time&#46; The high initial strength of the copolymer and its predictable breakdown profile guarantee secure wound support without interference in the critical process of wound healing&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">After surgical excision of the lesion following the tension lines of the relaxed skin&#44; we start the continuous subcutaneous suture at one end of the wound&#44; inserting the needle through the mid dermis and including the full thickness of the hypodermis&#59; we then introduce the needle into the hypodermis of the opposite side and bring it out through the mid dermis and&#44; without tying&#44; we continue the suture to the other end of the wound to complete closure of the deep plane&#46; We then continue with the same suture to perform the continuous intradermal suture&#46; On completion of the intradermal suture&#44; we tie the suture at the end of the wound where closure was initiated&#44; leaving the knot buried in the intermediate plane&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0030" class="elsevierStylePara elsevierViewall">This surgical technique is indicated for areas of tension&#46; These include areas with greater degrees of movement and&#44; therefore&#44; scars subjected to greater lateral tension &#40;for example&#44; on the trunk&#44; in particular the back&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Complications</span><p id="par0035" class="elsevierStylePara elsevierViewall">We have now used this technique in 25 patients&#46; In 1 case&#44; the suture material parted when the continuous subcutaneous suture was being tensed in a 10<span class="elsevierStyleHsp" style=""></span>cm defect on the shoulder&#46; This can be avoided by progressively tensing the continuous subcutaneous suture as it is being performed&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">To date&#44; with a postsurgical follow-up of 9 months&#44; we have observed no wound or scar dehiscence&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="par0045" class="elsevierStylePara elsevierViewall">The continuous suture is a rapid technique that allows us to perform direct closure in areas of tension&#44; preventing wound dehiscence&#46; In addition&#44; the unsightly marks on the borders of the scar are avoided and it is not necessary for the patient to return to outpatients to have the suture removed&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Videos of Surgical Procedures in Dermatology
Continuous Suture by Tissue Planes
Sutura continua por planos
C. Garrido-Colmenero
Autor para correspondencia
cristinagarrido86@gmail.com

Corresponding author.
, G. Blasco-Morente, I. Pérez-López, J. Tercedor-Sánchez
Unidad de Gestión Clínica de Dermatología Médico Quirúrgica y Venereología, Hospital Universitario Virgen de las Nieves, Granada, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">A number of recent publications have described various surgical techniques to prevent wound dehiscence in the immediate postoperative period and later scar dehiscence&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> The main objective in dermatologic surgery is to achieve complete excision of a tumor followed by the best possible functional and cosmetic outcome&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">At the 2005 Iberian&#8211;Latin American Dermatology Conference &#40;CILAD&#41;&#44; Serrano Falc&#243;n et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> presented a new surgical technique&#44; the vector-running subcutaneous suture&#44; improving on the technique proposed by Weber and Wulc<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> to prevent wound and scar dehiscence&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The technique we currently use in our center to prevent wound and scar dehiscence is the continuous suture by tissue planes&#46; This consists of a continuous subcutaneous suture followed by an intradermal suture&#59; it is an adaptable and simple technique that enables us to control tension forces in the wound until this has healed&#46; Furthermore&#44; the use of an intradermal suture avoids the unsightly marks left by external stitches and makes further attendance for suture removal unnecessary&#46; We use an absorbable suture material with a mid-term absorption time to avoid the formation of foreign body granulomas that can develop when nonabsorbable sutures are used&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Description of the Technique</span><p id="par0020" class="elsevierStylePara elsevierViewall">For the continuous suture we use 3&#47;0 Novosyn&#44; a coated&#44; braided synthetic suture of poly&#40;glycolide-co-l-lactid 90&#47;10&#41; with a mid-term absorption time&#46; The high initial strength of the copolymer and its predictable breakdown profile guarantee secure wound support without interference in the critical process of wound healing&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">After surgical excision of the lesion following the tension lines of the relaxed skin&#44; we start the continuous subcutaneous suture at one end of the wound&#44; inserting the needle through the mid dermis and including the full thickness of the hypodermis&#59; we then introduce the needle into the hypodermis of the opposite side and bring it out through the mid dermis and&#44; without tying&#44; we continue the suture to the other end of the wound to complete closure of the deep plane&#46; We then continue with the same suture to perform the continuous intradermal suture&#46; On completion of the intradermal suture&#44; we tie the suture at the end of the wound where closure was initiated&#44; leaving the knot buried in the intermediate plane&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0030" class="elsevierStylePara elsevierViewall">This surgical technique is indicated for areas of tension&#46; These include areas with greater degrees of movement and&#44; therefore&#44; scars subjected to greater lateral tension &#40;for example&#44; on the trunk&#44; in particular the back&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Complications</span><p id="par0035" class="elsevierStylePara elsevierViewall">We have now used this technique in 25 patients&#46; In 1 case&#44; the suture material parted when the continuous subcutaneous suture was being tensed in a 10<span class="elsevierStyleHsp" style=""></span>cm defect on the shoulder&#46; This can be avoided by progressively tensing the continuous subcutaneous suture as it is being performed&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">To date&#44; with a postsurgical follow-up of 9 months&#44; we have observed no wound or scar dehiscence&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="par0045" class="elsevierStylePara elsevierViewall">The continuous suture is a rapid technique that allows us to perform direct closure in areas of tension&#44; preventing wound dehiscence&#46; In addition&#44; the unsightly marks on the borders of the scar are avoided and it is not necessary for the patient to return to outpatients to have the suture removed&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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