Abstract
The placement of secure and effective deep dermal sutures is an essential determinant of the postoperative outcome and overall cosmesis of surgical reconstruction.1 The closure of high-tension wounds can be especially difficult because of the tendency to inadvertently lock the knot prior to achieving wound approximation by creating an “air-knot.” Closing high-tension wounds without relying on tissue creep or mechanical advantages, including pulley stitches or assistants, can be difficult.2
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