Cosmetic Skin Suture and Irregular Skin Wound Suture

Skin scars cannot be avoided, but its degree is closely related to the shape of the incision, local tension, blood supply, and other factors. In this chapter, we focus on the structure of the skin and the concept of relaxed skin tension line (RSTL). Through a detailed discussion of the tissue structure involved in suturing and the local tension of the incision, we try to make readers understand: (1) Influence of different tissue structures on the appearance of the incision after suturing; (2) Characteristics of local blood supply; (3) The distribution of human skin tension, so as to design the surgical incision and adjust the shape of the wound edge in irregular wound suture. In clinical practice, no matter well-designed surgical incisions or irregular wounds are seen in the ER, the cosmetic effect is the most concerned factor (sometimes the only factor) for the patients. Therefore, the demand for skin cosmetic suturing in modern surgery has been increasing. Skin cosmetic closure is achieved based on suturing principles, techniques, and suture selection. Although scarless cannot be achieved, flattering of the skin and the relative inconspicuity of the sear can be achieved. From a practical point of view, this section will sequentially describe the principles of skin cosmetic suture, suture techniques, suture techniques for irregular wounds, finally, the “Zhang’s super relaxation suture” with the ultra-small scar. Achieving clinical results of cosmetic skin closure requires not only familiarity with principles and mastery of suturing techniques, but also the application of appropriate surgical instruments and sutures. This is not to say that the smaller or the thinner the better, but to be familiar with the potential damage that different devices may cause to sutures and skin tissues. At the same time, different tissue reaction, absorption time, and strength of sutures of different materials will also affect the healing of the skin and the appearance of scars. In this chapter, we focus on the characteristics of commonly used surgical instruments and sutures and introduce in detail the suture selection experience of the Plastic Surgery Department, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine.