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The Cutting Edge: Challenges in Medical and Surgical Therapies |

The Lattice Stitch Technique

Keith Allen Knoell, MD
Arch Dermatol. 2011;147(1):17-20. doi:10.1001/archdermatol.2010.235.
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Extract

Surgical repair of excisional defects in severely atrophic skin or skin under tension can present several challenges to cutaneous surgeons.

REFERENCES
Wheeland  RGed Cutaneous Surgery.  Philadelphia, PA WB Saunders Co1994;
Nagasao  TIshii  NShimizu  YNakajima  T A tie-over with “untied” parallel stitches: a useful technique for fixation of a bolster after treatment of cryptotia. Scand J Plast Reconstr Surg Hand Surg 2007;41 (2) 88- 92
PubMed Link to Article[[XSLOpenURL/10.1080/02844310500539340]]
Dabbs  CHNeil  HG Surgical buttons. US patent 3664345 May23 1972;
Weiss  J A suture tightening device for closing wounds and a method for its use. US patent 6471715 October29 2002;
Cosmetto  AJ Skin tension set. US patent 5127412 July7 1992;
Westcott  MS Skin tensioning device. US patent 6120525 September19 2000;
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Figures

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Figure 1.

A drawing (A) and a photograph (B) show a series of complementary opposing anchor stitches placed at least 5 mm away from the wound edges, parallel to the wound.

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Figure 2.

Tying the anchor stitch over a surgical instrument prevents overtightening of the skin under the stitch.

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Figure 3.

Illustration of the basic lattice stitch and a simple lattice closure (A), a double-closure lattice stitch (B), a crossed lattice closure (C) and a near-far (stacked) anchor lattice closure. A, The closing stitch is placed through the skin over and completely around opposing anchor stitches and is tied from the center of the wound. A basic lattice stitch consists of 1 pair of opposing anchors and a single closing stitch. A series of basic lattice stitches together form a simple lattice closure. B, Double-closure lattice stitch. Multiple closing stitches can be placed over directly opposing anchor stitches for extra strength in a given closure area. C, Crossed lattice closure. Simple interrupted sutures are placed over and completely around opposing adjacent anchor stitches to close small defects between primary closure points and to realign wound edges. D, Near-far (stacked) anchor lattice closure. Adjacent anchor stitches are placed at different distances from the wound edge with a slight overlap, equidistant from complementary opposing anchors, to increase the density of closing points and to disperse forces parallel to the wound edge more widely in a nonlinear fashion.

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Figure 4.

Appearance of a simple lattice closure in the immediate postoperative period (A) and 2 months later (B). A, A simple lattice closure. B, Wound healing 2 months after a simple lattice closure.

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