๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Nonundermined repairs
Nonundermined repairs
While undermining is a standard technique to facilitate both lateral tissue movement and permit the placement of deeper buried sutures (such as the set-back suture), it is neither necessary nor appropriate in all situations. As noted above, undermining itself leads to some vascular compromise as has been demonstrated in a porcine model.
Markedly atrophic skin should almost never be undermined. This is not due to concern regarding skin tear or skiving, but rather because with atrophic skin, the underlying fibrous attachments between the underside of the dermis and the deeper subcutaneous tissues provide the greatest purchase for buried sutures. A modified simple buried dermal suture is used in these cases, taking as large a bite as possible on each side, beginning on the undersurface of the deep subcutaneous tissue or even underlying fascia. Avoiding undermining may permit such wounds to be closed easily without resorting to adjuvant approaches such as suturing through tissue adhesive bolsters.61,62
Second, wounds in areas of very poor baseline perfusion, such as the lower legs, may sometimes be repaired without undermining. This serves two purposes: first, it obviates the risk of perfusion reduction secondary to undermining proper, and second, it creates a smaller subdermal defect in the event of dehiscence.