Presutures for skin stretching: Step 1 (large photo)
After administering a tranquilizer or neuroleptanalgesic, prepare the skin around the lesion for aseptic surgery. Then inject a local long-acting analgesic agent (e.g. bupivacaine) around the lesion.
To place the sutures in the skin on either side of the lesion or defect, use 2-0 or 3-0 nonabsorbable synthetic monofilament suture material (nylon or polypropylene) with a swaged cutting needle. Another option is to use suture material one or two sizes larger than what will be used to close the wound. The larger diameter may distribute tension better and may be less likely to cut into the tissues. However, the larger the diameter of nylon or polypropylene, the greater the potential for difficulties with knot security.
Using a Lembert suture, place the first bite in the skin and out of the skin on the same side of the wound.