This technique was developed for closing wounds with an atrophic dermis or where tissue tear through is a major problem, such as on the lower legs and forearms in patients with extensive actinic damage. It is much faster than other approaches, such as the lattice stitch, and concomitantly does not share some of the lattice stitch’s drawbacks that are rooted in oversewing the wound.
One variation of this technique has been described using a hydrocolloid dressing as a bolster, while another variation has focused on utilizing cyanoacrylate glue to bolster the atrophic dermis. The glue is allowed to harden on the skin, adding strength to the atrophic epidermis in a similar fashion to the adhesive strips. While providing a benefit in terms of elegance and ease of wound care, the additional cost of the individually packaged glue for this technique may make it less readily adopted. Regardless of the particular bolster material used, the principle of this approach remains the same—an externally applied material is used to adhere to and strengthen an otherwise atrophic surgical site, permitting placement of sutures when the suture material would otherwise have found little purchase in the thin skin.
In order to recruit maximal dermis, the horizontal mattress technique, as described previously, is often used with this approach, though other techniques, such as simple interrupted sutures or vertical mattress sutures may be utilized as appropriate.
Care should be taken to avoid skimming the needle superficially beneath the epidermis. This results from failing to enter the skin at a perpendicular angle and failing to follow the curvature of the needle. This may result in wound inversion as the tension vector of the shallow bite pulls the wound edges outward and down.
It is possible to utilize absorbable sutures with this approach as well by incorporating percutaneous approaches, such as the percutaneous set-back dermal suture, so that the percutaneous bites of suture material also capture part of the adhesive strip in order to increase their security. In this case, however, the adhesive strips should be carefully removed approximately 2 weeks postoperatively.