title: The "modified" winch stitch.
abstract: BACKGROUND
  The methods described to achieve intraoperative tissue expansion have drawbacks.
  
  
  OBJECTIVE
  To report an intraoperative tissue expansion technique using standard suture material and hemostats to create a "modified" winch stitch.
  
  
  METHODS
  A continuous running suture is placed with both ends left free. A "fixed" hemostat is placed above the skin at one end. After pulling at the other end with a second hemostat, a third hemostat is placed proximal to this hemostat just above the skin, which is left in place to produce stretching. The second and third hemostats are then used in an alternating pulling and holding fashion.
  
  
  RESULTS
  This method produces significant tissue expansion. If the desired degree of approximation is achieved, the ends of the suture can be tied together, as in the previously described winch stitch.
  
  
  CONCLUSIONS
  The modified winch stitch is a simple and inexpensive means to facilitate closure of wounds under a significant amount of tension.
authors.affiliation: Department of Medicine (Dermatology), Pathology, and Otorhinolaryngology, Kansas University Medical Center, Kansas City, Kansas, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Casparian
authors.forename: E J
authors.initials: EJ
authors.lastname: Rodewald
authors.forename: G D
authors.initials: GD
authors.lastname: Monheit
mesh_terms: D006801:Humans; D013536:Suture Techniques; D015626:Tissue Expansion / Q000379:methods*; D014947:Wounds and Injuries / Q000601:surgery*