Rapid Pearls: Surgery on Thin Skin

In this presentation by Maggie Chow, an assistant professor at USC, strategies for suturing wounds on thin skin are discussed. Thin skin, often resulting from aging, sun damage, or medications, poses challenges during surgical closures, as sutures can tear the skin. Chow proposes two main techniques to mitigate this risk: using adhesives and horizontal mattress sutures. Adhesives can be applied on either side of a wound to help distribute tension and prevent tearing when sutures are placed. Chow highlights various adhesive options, including wound closure strips and waterproof transparent dressings, which assist in healing more quickly compared to granulation. The second method, horizontal mattress sutures, spreads the force over a larger skin area than simple sutures, reducing the likelihood of tearing and avoiding skin inversion. To facilitate ease of removal after some days, these sutures may be tied at intervals. Chow emphasizes the importance of considering these approaches when handling closures on patients with fragile skin, suggesting that they can significantly improve the outcomes of such surgeries.