The corset plication suturing technique is typically used in wounds wider than 4cm. It is suitable for wounds under excessive tension, particularly those on the shoulders and back. Corset plication suturing is a deep technique, and enables natural wound eversion and improves approximation of wound edges. Using corset plication stitches has proved to markedly reduced the diameter and tension of the wound. It also eases the following placements of intradermal stitches.
Technique of Corset Plication Stitches
Before inserting the needle, pull on the tissue firmly with forceps to ensure the strength of the tissue. Starting at one end of the ellipse, insert the needle perpendicular to the wound’s surface through the deep fat 2-4mm towards the center of the undermined edge of the wound. The first ‘bite’ is performed by penetrating the fascia and, observing the curve of the needle, exiting nearer to the wound edge that is incised. Again, the suture can be slightly pulled to confirm that the desired ‘bite’ of fascia has been taken. The loose end of the suture material should be kept distal to the initial ‘bite’ while attention is turned to the other side of the wound edge. Perform the second ‘bite’ by repeating the process on the opposite side. The entire procedure from the perpendicular insertion of the needle in the first ‘bite’ to the second ‘bite’ is then replicated in a sequence in pairs in the direction of the contralateral pole of the wound. After taking the number of paired ‘bites’ needed, the ends of the suture material are tightly drawn and tied onto itself.
Possible Risks of Corset Plication Stitches
The corset plication stitch technique is especially useful for larger wounds that are under marked tension, but it is important to remember the possible risks involved in this technique. The strength of the suture depends on the fascial layer septations underneath the subcutaneous tissue being included. If the tissue ruptures in the postoperative period after the surgical operation, then tension would be widely distributed. This increases risks of wound distortion and breakage of the suture.
Type of Suture to Use for Corset Plication Stitches
Choosing the best type of suture to use for corset plication stitches is largely determined by the location of the wound. As the corset plication technique is supposed to ‘bite’ the fascia, typically a larger-gauge suture can be used. For example, a 2-0 or 3-0 absorbable suture can be used for areas like the back and shoulders. Also, monofilament suture material is recommended since the running technique relies on pulling through long stretches of suture thread. Monofilament suture helps to reduce the factor of friction.
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