Large defects may at first appear to be too big to close in a side-to-side fashion. Certain
wounds and situations may call for healing with second intent. Undermining and pulley
sutures are very helpful in bringing together
wound edges of certain large openings. Partial closures may decrease the tendency to exert unwanted tension against a free margin, decrease the size of the
wound allowed to heal with second intent, shorten the duration of healing, and keep
scars within one cosmetic unit. Buried
sutures should be placed and laid beside the
wound without tying the knot until the surface stitches or the external device approximates the
wound edges. In this way, one can be certain that the buried stitch will provide adequate support to the infrastructure of the
wound. Intraoperative skin expansion may help close
wounds that could not be closed by any other technique except for
skin grafting.