This One Suture Technique Can Make A Big Difference for Nasal Defects!
🤔 Curious to know about...What is a basting suture and considerations when using it on rhombic flaps for nasal defects?....(This post is to answer one of our Surgical Dermatology NP/PA Community members', Galina Serdtsev, question from yesterday's post. Thanks, Galina Serdtsev ! ❤️)...
How is the basting suture placed when performing a Rhombic Flap Design for a nasal defect?
In the pics, I placed a yellow asterisks where I would place my basting suture.
If you look at the left picture, you can see where I would first insert my needle at the wound bed of the defect (1). After exiting, I then re-enter into the underside of the flap (2), not going through-and-through. This is a deep suture technique most times (although there are times when I do go through-and-through if I see that flap vascularity is not compromised…or if I am placing basting sutures to tack down a FTSG b/c skin is so thin).
In the middle picture, you can get a better visual of the basting suture’s final placement once tied off. But again…I do not typically go through-and-through in this case b/c I would NOT want to constrict vascularity, causing necrosis. I try to take a conservative, scant bite into the flap, as possible, being mindful of that.
What is the purpose of a basting suture?
The purpose of a basting suture is to:
- Prevent pincushioning as it tacks down the underside of the flap into the wound bed more securely
- To close any dead space and prevent hematoma formation
- Helps open up nasal valve
I use this, mostly, for any bilobes and rhombics that I perform on the nose (If I can).
My least favorite thing with rhombics and bilobes is the pincushioning that can develop b/c of, theoretically, the contraction that occurs with time. So, I learned this technique in the literature when I was trying to figure out how to prevent pincushioning. Have been using it since and have noticed a difference! There is one other technique I use to prevent pincushioning, but which will be another lengthy post 😩 and will save that for another day (ha)!
Tips to be mindful of (Hint: Test for Vascularity!!!)
2 tips to be mindful of when performing this technique is to test for vascularity and ensure the basting suture is not too constricting … Super important! Don’t skip these steps!
- If you notice that once you place a basting suture (or any suture at that), if it makes your flap gray, blanched, or dusky…REMOVE!!!
- Always reassess your technique. Ask yourself…did you take too large of a bite?...Does the flap have enough blood supply to begin with to support this technique?...
If you see that your flap’s vascularity is still compromised after re-attempting, then I DO NOT recommend performing it. Just monitor the pincushioning in the postops (especially at 3 months b/c it takes time for that to develop. Kenalog can be anticipated to be used if needed later on).
Other Considerations…
And lastly, I generally place only one tacking suture in this design.
The less is better…again…being mindful of not impeding vascularity.
If you look at the picture to the very right. For the flap edges, no deeps placed, just all epidermal simple interrupted sutures to promote vascularity! B/C there is minimal tension to the wound, deeps not necessary, and epidermal sutures will still be removed in 1 week with no risk of dehiscence!
Well, that’s how to use a basting suture in a rhombic flap in a looong nutshell ha!
I really hope this helps!
ALL my BEST,
Theresa (TheresaSurgDermNP) ❤️
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