title: Defect closure with "8-shaped crisscross tensile suture" technique.
abstract: BACKGROUND
  Sutures and suturing techniques compose the basis of the surgery. Although many surgical methods such as the skin grafts or flaps has been described for the closure of large defects, proper primary suturing may sometimes yield very successful results and decrease the need of complicated procedures. In this article, a new combined skin-subcutaneous tissue suturing technique called as "8-shaped crisscross tensile suture (8CTS)" designed for the closure of large skin defects is presented.
  
  
  METHODS
  One hundred forty-nine patients with an age distribution between 14 and 65 y were operated for large skin defects by using the 8CTS technique. The most common etiology of the defects was free flap donor sites, and the most common defect localization was the anterolateral thigh region. The average defect width on the axis of primary closure was calculated as 14.6 cm. The 8CTS technique is a combination of both skin and subcutaneous layers suturation and may even involve deeper layers suturation according to the depth of the defect.
  
  
  RESULTS
  Eight complications including wound dehiscence, early recurrence of pilonidal sinus disease, seroma formation, skin-edge necrosis, and incisional hernia were observed. The wounds of 141 patients were treated successfully.
  
  
  CONCLUSIONS
  The 8CTS technique is a useful method for the closure of large defects eliminating the need of more complex procedures and providing acceptable cosmetic results while supporting both skin and subcutaneous tissue in one suture.
authors.affiliation: Department of Plastic Reconstructive and Aesthetic Surgery, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey.
authors.forename: Nebil
authors.initials: N
authors.lastname: Yeşiloğlu
authors.affiliation: Department of Plastic Reconstructive and Aesthetic Surgery, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey. Electronic address: drhakansirinoglu@gmail.com.
authors.forename: Hakan
authors.initials: H
authors.lastname: Şirinoğlu
authors.affiliation: Department of Plastic Reconstructive and Aesthetic Surgery, Bezmi Alem Vakıf University Medical Faculty, İstanbul, Turkey.
authors.forename: Kemalettin
authors.initials: K
authors.lastname: Yildiz
authors.affiliation: Department of Plastic Reconstructive and Aesthetic Surgery, Akdeniz University Medical Faculty, Antalya, Turkey.
authors.forename: Arzu Özcan
authors.initials: AÖ
authors.lastname: Akçal
authors.affiliation: Department of Plastic Reconstructive and Aesthetic Surgery, Istanbul Cerrahi Hospital, İstanbul, Turkey.
authors.forename: Gürsel
authors.initials: G
authors.lastname: Turgut
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008408:Mastectomy; D008875:Middle Aged; D013524:Surgical Flaps; D013536:Suture Techniques; D055815:Young Adult
keywords: Composite defect; Large wound; Primary closure technique; Suturing technique