Like the percutaneous suspension suture, this is a niche technique designed to fix the base of a graft to a deeper structure and is typically used when fixing a graft to underlying structures to minimize the risk of dead-space/hematoma formation and maintain close approximation between the underside of the graft and the underlying vascular bed. This may be used as an alternative or adjunct to tie-over bolster dressings for graft fixation, as the literature is equivocal on the relative benefits of basting sutures and bolster dressings.
Depending on location, a 4-0, 5-0, or 6-0 nonabsorbable or fast-absorbing suture may be used.
After one edge of the graft has been fixed—or, at a minimum, a single suture has been placed to fix the graft, ideally on the distal edge relative to the surgeon—the suture needle is inserted at 90 degrees from the outside of the skin overlying the desired tacking point directly through the dermis, exiting on the undersurface of the graft at the point where fixation to the underlying anchoring point is desired. Since only the distal edge has been fixed, the graft can be gently reflected back, and the exit point of the needle can be easily visualized.
The needle is then gently pulled through the graft, regrasped, and inserted through the base of the graft bed at the desired point, and the needle’s curvature is followed to take a small bite. Gentle tension can be exerted if desired to ensure than an adequate bite was taken.
The needle is then reloaded and inserted back through the underside of the reflected graft adjacent to its original exit point so that it exits on the outside of the graft.
The suture material is then tied using an instrument tie (Figures 5-40A, 5-40B, 5-40C, 5-40D, 5-40E, 5-40F, 5-40G).
Overview of the basting suture.
The needle is inserted percutaneously at the desired location, directly through the graft.
The graft is reflected back, and the needle emerges through the now exposed underside of the graft. It is then reloaded.
The needle is inserted blindly through the base of the graft recipient site, a small bite is taken, and the needle then exits from the base of the graft.
The needle is then reloaded and ...