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Introduction

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Video 5-29. Lembert suture
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Application

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This is a niche technique designed to encourage wound-edge inversion, and is useful primarily to recreate a natural crease. It may be used to recreate the alar creases as well as to better define the helical rim, and may also be useful when recreating the mental crease.

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Suture Material Choice

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With all techniques, it is best to use the thinnest suture possible in order to minimize the risk of track marks and foreign-body reactions. Generally, this suture is used on the face and ears, and therefore a 6-0 or 7-0 monofilament suture may be best, though fast-absorbing gut may be used to obviate the need for suture removal.

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Technique

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  1. The needle is inserted perpendicular to the epidermis, approximately 8 mm distant to the wound edge.

  2. With a fluid motion of the wrist, the needle is rotated superficially through the dermis, and the needle tip exits the skin 2 mm distant from the wound edge on the ipsilateral side.

  3. The needle body is grasped with surgical forceps in the left hand and reloaded onto the needle driver.

  4. The needle is then inserted perpendicular to the skin on the contralateral side of the wound edge, 2 mm distant from the wound edge.

  5. The needle is again rotated superficially through its arc, exiting 8 mm from the incised wound edge.

  6. The suture material is then tied off gently, with care being taken to minimize tension across the epidermis and avoid overly constricting the wound edges (Figures 5-29A, 5-29B, 5-29C, 5-29D, 5-29E, 5-29F, 5-29G).

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Figure 5-29A.

Overview of the Lembert suture.

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Figure 5-29B.

The needle is inserted through the skin far lateral to the wound edge.

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Figure 5-29C.

The needle then exits the skin, still lateral to the wound edge.

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Figure 5-29D.

The needle is then inserted through the skin on the contralateral side of the wound, slightly lateral to the edge of the wound.

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Figure 5-29E.

The needle then exits further lateral from the edge of the wound.

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Figure 5-29F.

Appearance after suture placement but prior to tying.

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Figure 5-29G.

Immediate postoperative appearance. Note the marked wound eversion.

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