Presutures for skin stretching: Introduction (large photo)

source-image
May 29, 2009
By dvm360.com staff

Presutures are Lembert sutures placed in healthy skin on either side of a lesion. Placed several hours before the lesion is débrided or excised, these sutures stretch the skin around the lesion. They are usually placed eight to 12 hours before wound closure. The sutures are typically indicated for limb wounds in which the edges cannot quite be initially apposed (see figure) or for the removal of lesions (tumors) on the limbs that will result in such a wound. The technique is indicated if, in the surgeon’s judgment, the wound will eventually close without the use of a graft or flap.1,2 If there is concern that the tension on the presutures might cut into underlying tissues (e.g. wound, tumor), you can place a primary bandage pad and some secondary padding over these tissues. In some instances, the use of presutures may not be advisable. For example, if pressure from the sutures might result in degranulation of a mast cell tumor, the procedure should probably not be used. If primary skin closure is not possible, open wound management or skin grafting is an option.

Presutures stretch skin to allow wound closure. They can be used alone or in conjunction with other tension-relieving techniques, such as an adjustable horizontal mattress suture or multiple punctate relaxing incisions, if the presutures alone do not provide sufficient relaxation. A disadvantage of presutures is that they may cause a biologic tourniquet—the skin may become circumferentially too tight. If this occurs, the tourniquet effect can be released by removing the sutures. If signs of impaired circulation occur, such as swelling and hypothermia of the digits, they are a warning that primary skin closure may not be possible and a graft or flap may be needed for reconstruction.

REFERENCES

1. Scardino MS, Swaim SF, Henderson RA , et al. Enhancing wound closure on the limbs. Compend Contin Educ Pract Vet 1996;18:919.

2. Swaim SF, Henderson RA . Small animal wound management. 2nd Ed. Baltimore, Md: Williams & Wilkins, 1997;173-175.

Editors’ Note:
This technique was demonstrated on a canine specimen obtained from a specimen supply company.

Acknowledgment
Thank you to Lori Lind, RVT, Gladstone Animal Clinic, Gladstone, Mo., for her assistance during the demonstration.

Steven F. Swaim, DVM, MS
Professor emeritus
Scott-Ritchey Research Center
Department of Clinical Sciences
College of Veterinary Medicine
Auburn University
Auburn University, AL 36849

Step by Step Article
Video of the procedure

ADVERTISEMENT

Photo galleries

Voting open for Veterinary Pet Insurance’s Hambone Award

DVM360 MAGAZINE - Sep 18, 2014

By dvm360.com staff

Nominees selected are group of most unusual pet insurance claims for 2014.

Your veterinary clinic cat texts again

FIRSTLINE - Sep 06, 2014

By dvm360.com staff

CC the Clinic Cat has practice improvement ideas and a penchant for texting. See this clever kitty’s list of demands to keep her feeling feline fine at your veterinary practice.

The dogs of CVC Kansas City 2014

FIRSTLINE - Aug 26, 2014

By dvm360.com staff

We sniffed out the cutest canines at the conference and compiled a dizzying array of dogs in this quick, feel-good video.