All desirable scars are alike; all undesirable scars are undesirable in different ways. For millennia, surgical and traumatic wounds have been closed with sutures and similar materials, yet it was only with the introduction of local anesthesia 130 years ago that surgeons were able to move from focusing on the most rapid suture placement technique to the most effective. From William Halsted’s promotion of the buried suture technique in the late nineteenth century to contemporary articles on the subtleties of suture placement and tissue handling, a paradigm shift has taken place, with an increasing appreciation that not only are there multiple available approaches for any single suture placement, but that this choice may impact outcomes.
Shifting tension as deep as possible in the surgical wound is the key principle of suture placement, and indeed, adhering to this approach leads directly to improved patient outcomes, both functionally and aesthetically. Tension across the superficial dermis leads to increased scarring; shifting this tension to the deep dermis or even the fascia and suturing in a fashion that keeps the tension deep permit wounds to heal with the subtlest of scars.
The surgical literature is rife with myriad techniques with flashy names and multiletter acronyms. While sexy and catchy technique names and acronyms are sometimes appealing, they do little to describe a technique or place it within the larger context of other fundamental and well-established approaches. Moreover, this tendency increases the risk that previously described approaches could simply be shined off, dressed up, and renamed as ostensibly novel approaches—something that only serves to increase confusion for the novice and expert alike, since developing a common language is an important step in improving techniques and therefore outcomes. When possible, the second edition of Atlas of Suturing Techniques: Approaches to Surgical Wound, Laceration, and Cosmetic Repair utilizes descriptive names for suture techniques so that the nature of the technique is, at least somewhat, described by its name. Furthermore, when possible, techniques are explained in the context of the existing literature; for example, the “running looped suture” does not tell the reader what the technique entails, but referring to it as a “running locking horizontal mattress suture” suddenly allows the reader to understand the fundamental approach, even in the absence of a multipage description.
In the interest of consistency and developing a meaningful and translatable nomenclature, some liberty has been taken in (re)naming techniques so that they make intuitive sense. Therefore, for example, what was described in the literature as the “modified tip stitch” is referred to as the “modified vertical mattress tip stitch,” and what was originally named as the “vertical mattress tip stitch” is instead referred to as the “hybrid mattress tip stitch.” Once the reader has an understanding of the techniques on which these approaches are based, the value of the slight shift in nomenclature should become obvious. This shift in terminology is not meant as ...