Two Layer Skin Closure

■ The skin edges are closed with concealed subcutaneous interrupted 3.0 Monocryl sutures. Each successive suture bisects the wound length; this prevents "dog ears" at the end of the sutures. It is best if the sutures are started at the distal end and progress to the middle. Suturing can then be started at the proximal end (axilla) and continued to the middle.

■ Complete wound closure is then carried out with two-layer 4.0 Monocryl interrupted sutures. The wound is closed, therefore, with so little tension that the cutaneous suturing (running or intracutaneous) then only plays a minor role.

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