Running pleated suture technique apposes wound edges of unequal lengths

BACKGROUND Cutaneous advancement flaps, such as the T-plasty or H-plasty, are commonly used in order to relocate standing cones away from critical structures. In this process, what would have been the tips of a standard elliptical closure are displaced laterally as Burrow's triangles. This method creates additional terminal incision lines, perpendicular to the force vector of the flap. OBJECTIVE To describe a suture technique commonly employed in our practice that eliminates the need for such Burrow's triangles, hence minimizing suture lines and enhancing cosmesis. MATERIALS AND METHODS Through the described "running pleated" suture technique, excess tissue created by flap advancement is distributed equally along the entire length of the incision. RESULTS All patients did well postoperatively with excellent wound healing and superior cosmetic outcomes. CONCLUSION The "running pleated" suture technique obviates the need for large, laterally displaced Burrow's triangles that are normally created during the construction of flaps such as the T-plasty and H-plasty and can be a powerful tool in the armamentarium of any dermatologic surgeon.