What to Do for Thin-Skinned Patients

Many elderly patients have fragile, atrophic skin. Tears can occur easily in such skin when you are suturing margins together or when the area is under stress (eg, around a joint). To prevent such tears, apply mastic gum liquid adhesive to each margin edge, fan dry until tacky, then apply a butterfly strip the length of each margin; insert the needle through the butterfly strip and close. The resultant suture will have reinforced edges that won't tear or dehisce.