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We read the short report of Ahmed and Ahmed's success with the ‘recovery suture’, which seems to have been beneficial in subcuticular closure of abdominal wounds, with great interest.
Coincidentally, we were in the process of preparing a report of a similar technique, which has been used successfully for a number of years in closure of the preauricular incision following a facelift. As the schematic (Fig. 1) shows a subcuticular closure is performed with 5/0 Prolene and the ends left long, but before being tightened, a loop of a smaller calibre suture, e.g. 6/0 Ethilon, is placed around the initial stitch and tied with the ends left slightly long. On tightening, the secondary suture is pulled into the wound leaving its ends protruding through the centre of the wound (Fig. 2) . The purpose of this manoeuvre is evident in the presence of post-operative haematoma when traction of the smaller stitch delivers the subcuticular one allowing it to be loosened sufficient to allow egress of blood, and the ingress of a suction cannula, without having to return the patient to theatre for more formal evacuation and resuture. After sufficient time, the subcuticular suture may be re-tightened. Both sutures are removed in the normal fashion after 5–7 days. This ‘trapdoor’ suture has been of proven benefit on a number of occasions and we offer it for those who may wish to try it.
Figure 1Schematic of the secondary ‘trapdoor’ suture's application around a standard subcuticular closure in preauricular closure of the facelift incision.
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