Wound closure in general
By Mathias Mejdahl, MD, PhD
When wound closure is performed, it should be done with the least possible closure tension necessary to approximate the wound margins. Tension can be minimized by placing proper dermal sutures. Further, the addition of dermal sutures will also assist with the reduction of dead space and creating proper skin edge eversion. Closure of the subcutaneous fascia also reduces dead space. When placing a suture, regardless of the type of suture, it is important to match the entry and exit points of the suture on both sides. Otherwise, you will get an uneven wound closure and poor edge eversion resulting in an unsatisfying aesthetic result. It is important to create a slight eversion of the skin edges when closing a wound. Poor eversion will often happen when the needle enters too far from the skin, or it enters at an improper angle.
Correct instrumentation is also important. The needle driver should be held with the 1st and 4th finger and guided by the 2nd and 3rd finger. When arming the needle driver, the needle should be grasped with the tip of the needle driver 2/3 of the way up from the point of the needle. If it is placed closer towards the point, it is difficult to take advantage of the curvature properties of the needle. Placing it further away from the point will weaken the needle. Preferably, the needle should only be grasped with forceps and needle driver, and not with the hand, as it increases the risk of needle stick injuries. It is also important never to grasp the needle at its point, as it will make the needle blunt.