Chapter 5.31: The Lattice Stitch

Introduction

Application

This is a niche technique designed for wounds with an atrophic dermis or under significant tension, where traditional suturing techniques do not allow for adequate tissue recruitment and wound-edge apposition or tension relief. The fundamental principle is to place several interrupted sutures parallel to the wound edge and then tie the interrupted sutures over the wound edge by incorporating the lattice, increasing the stability of the repair and broadly distributing its force.

Suture Material Choice

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. A 5-0 monofilament suture material may be used if there is minimal tension, and 4-0 monofilament suture in areas under moderate tension. In select high-tension areas, 3-0 monofilament suture may be utilized as well.

Technique

1. Simple interrupted sutures are placed parallel to the incision line, forming the anchoring framework: the needle is inserted perpendicular to the epidermis, approximately 8 mm distant from the wound edge.

2. With a fluid motion of the wrist, the needle is rotated through the dermis, running parallel to the incision line.

3. The suture material is then tied off loosely, leaving a gap between the suture material and the skin.

4. Steps (1) through (3) are then repeated on the contralateral wound edge, forming the contralateral anchoring framework.

5. A simple interrupted suture is then placed, incorporating the suture material from the anchoring framework. The needle is inserted around the anchoring suture on the far end perpendicular to the epidermis.

6. With a fluid motion of the wrist, the needle is rotated through the dermis, taking the bite wider at the deep margin than at the surface, and the needle tip exits the skin on the contralateral side, on the outside of the anchoring framework.

7. 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 5-31A, 5-31B, 5-31C, 5-31D, 5-31E, 5-31F, 5-31G, 5-31H).