Subcuticular Closure

The vertical skin has been gathered to varying degrees by various authors [27-30]. The thinking behind this is to help shorten the length of the vertical closure. Although loose skin inferiorly can perhaps be encouraged to tighten up somewhat, overgathering of the skin just slows healing. There are two important points to note about the vertical incision and gathering.

First, the vertical closure can accommodate significant length because of the increased projection inherent in this procedure. Second, if this length is measured postoperatively, it eventually lengthens out and excessive gathering does not lead to a shorter scar; instead it leads to impaired wound healing because of excessive constriction of the skin.

If gathering is performed, it should be confined to the loose skin at the lower end of the incision. I have been gathering this area less and less and I have found that the odd shape inferiorly settles down more quickly if minimal gathering is performed. If the vertical opening measures 14 cm, I might now gather it to about 12 cm. If the vertical opening measures 10 cm, I might now gather it to 9 cm.

It is very important to take small bites of the dermis and not to backtrack with the subcuticular suture. Otherwise the tension on the suture will cause constriction and interfere with the circulation to the skin edges. If there are small gaps left at the end, these can easily be approximated with tape.

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