Surgical challenge
Over the last few months, the COVID-19 pandemic has nearly saturated the resources of many health systems, making it essential to reduce the number of patient visits to medical centers and hospitals. After minor surgical procedures, dermatology patients need to return for suture removal. We propose a suture technique that allows a patient to remove the stitches at home with 1 hand, using medical gloves. It is recommended for punch biopsies or small skin excisions.
Solution
The looped square slip knot technique avoids the need to use sharp instruments to remove sutures after surgery.1 This type of knot has been tested previously, with no significant difference in strength or security from that of the interrupted simple surgical knot.2 After the skin specimen is excised, the knot is tied by grasping the loose end 1 cm away from the wound (Fig 1 , A), leaving at least 3 cm between the needle holder and the distal loose end. After tying it with a double throw, a loop is formed (Fig 1, B, C), leaving the tail end longer than the other end (Fig 2 , A). To prevent the knot from accidentally unraveling during wound care, tail-end sutures are fixed to the adjacent skin with wound closure strips (Fig 2, B). After several days, the patient will be instructed to pull on the wound closure strips to remove the stitches. This technique can be performed at home and may be used on any area of the cutaneous surface. Educating patients or companions on how to manage the wound and remove the stitches with a clean technique at home is essential.
Fig 1.
A, The loose end is grasped with the needle holder 1 cm away from the wound. B, Making the first throw. C, Making the second throw.
Fig 2.
A, The loose end is cut. B, Tail-end sutures are fixed to the adjacent skin with wound closure strips.
Conflicts of interest
None disclosed.
Footnotes
Funding sources: None.
IRB approval status: Not applicable.
Reprints not available from the authors.
References
- 1.Sasaki A., Fukuda O. The looped square knot: A useful suture method. Plast Reconstr Surg. 1981;67(2):246–252. [PubMed] [Google Scholar]
- 2.Jianmongkol S., Hooper G., Kowsuwon W., Thammaroj T. A comparative biomechanical study of the looped square slip knot and the simple surgical knot. Hand Surg. 2006;11(1-2):93–99. doi: 10.1142/S0218810406003152. [DOI] [PubMed] [Google Scholar]