Techniques for High Tension Areas: How to Get Out of a Bind

In this presentation, the speaker shares techniques for managing high-tension areas during surgical closures, particularly for patients who are at higher risk due to blood thinner usage. One of the primary techniques discussed is the use of buried pulleys, or double deep stitches, which distribute tension more evenly across four points instead of two, making closures easier and minimizing tension points. The speaker also describes the use of assistive devices that act as external pulleys, which can relax tissue without damaging the epidermis, especially useful in areas like the scalp. The technique involves threading sutures through these devices and allowing time for the skin to relax, either by tying off the sutures or clamping them temporarily. Additionally, the speaker advocates for using tacking stitches to stabilize flaps in high-tension areas, such as around the eyelid and zygomatic regions. Overall, these techniques focus on simplifying repairs while ensuring patient safety, particularly in sensitive cases.