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Interestingly just rotated through plastic surgery and found that a number of my attendings had recently started putting all their knots on the outside for just about everything. Running subcuticular with monocryl and just tying the knots outside. Then, just pulling out the knots/cutting them if they were still there on the first post-op visit. They claimed that a number of plastic surgeons were discussing this method favorably at meetings.
Initially the results seemed pretty good to me.
or no knots at all. Bring the suture out through each end of the wound and tape it down with a steri strip. At the first visit take off the steri strip and cut the end of the monocryl off. A thousand ways to get things done. But like some of the others have said, a lot of it goes into good planning but a lot of it is out of our control.