The effect of stitch type on flap tip blood flow

Abstract

Background: The 3-point corner stitch is generally used for apposition of skin flap tips to recipient wound corners. This stitch theoretically provides better blood flow, leading to improved flap tip survival, than alternative suture techniques. However, this assumption is not based on human experimental data. Objective: We tested in patients whether certain stitch types influence flap tip blood flow and necrosis. Methods: Flap tips were closed with either a 3-point corner stitch, a vertical loop stitch at the tip, or two vertical loop stitches adjacent to the tip. Blood flow was indirectly measured by means of the laser Doppler imager, and flap tips were observed for subsequent necrosis. Results: The 3-point corner stitch resulted in a higher overall mean percent flux ratio implying greater blood flow than the other stitch types used. However, none of the stitch types resulted in a large number of necrotic flap tips. Conclusion: The 3-point corner stitch provides increased blood flow to flap tips that may be critical when flap tip survival is problematic. (J Am Acad Dermatol 2001;44:265-72.)