title: "Running pleated" suture technique opposes wound edges of unequal lengths.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology, University of Maryland, Baltimore, and The Kenilworth Surgery Center, Towson, Maryland 21204, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Kouba
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Miller
mesh_terms: D002921:Cicatrix / Q000517:prevention & control; D062109:Dermatologic Surgical Procedures; D006801:Humans; D019651:Plastic Surgery Procedures; D012867:Skin / Q000293:injuries*; D013524:Surgical Flaps; D013536:Suture Techniques; D014945:Wound Healing