Fig. 140.1 Simple laceration.

Fig. 140.2 Demonstration of the pinching of the skin with the thumb and forefinger, just behind the area of injection with the anesthetic. Note the perpendicular relationship of the needle to the thumb and forefinger.

Fig. 140.3 (A) The tape is placed on one side of the wound at its midpoint while the clinician grasps it with forceps in the dominant hand. The opposite wound edge is then gently apposed by pushing with a finger of the nondominant hand. (B) The remaining open sections of the wound are bisected by additional tape strips until the strips are within 2 to 5 mm of each other.

Fig. 140.4 Closing a long or complex wound. (A) The wound is bisected with a strip of surgical tape. (B) The wound limbs on either side of the tape are glued. (C) The strip is removed, and the central portion of the wound is glued. Some practitioners prefer to leave the tape strip and apply the adhesive over it.

Fig. 140.5 (A) To prevent inadvertent runoff of the Dermabond adhesive, position the wound in a horizontal plane. Manually approximate the wound edges with forceps or gloved fingers. Use gentle brushing strokes to apply a thin film of liquid to the approximated wound edges, and maintain proper eversion of skin edges as you apply Dermabond adhesive. The adhesive should extend at least ½ cm on each side of the apposed wound edges. Apply Dermabond adhesive from above the wound. (B) Gradually build up three or four thin layers of adhesive. Ensure that the adhesive is evenly distributed over the wound. Maintain approximation of the wound edges until the adhesive sets and forms a flexible film. This should occur about 1 minute after applying the last layer.

Fig. 140.6 Hair apposition technique. (A) Choose four to five strands of hair in a bundle on either side of the scalp laceration. (B) Using artery forceps, cross the strands. (C) Make a single twist to appose the wound. (D) Secure with a single drop of glue.

Fig. 140.7 Absorbable intradermal sutures.

Fig. 140.8 Simple sutures.

Fig. 140.9 Simple running suture.

Fig. 140.10 Vertical mattress suture.

Fig. 140.11 Simple suture removal.