February 22, 2018

Sheaf of Tags

I learned a suture trick back in the day from a wonderful ophthalmologist, to prevent suture tags irritating the eye and to make suture removal near the eye much easier. I have the recipe below, and some rudimentary (!) drawings to demonstrate.

I use this for any suturing near the eye, primarily entropion, but works well too for mass removals at or near lid margins.

1) Use fine suture. (I rarely use larger than 5-0 monofilament when suturing near the lids.)

2) Apply your first simple interrupted suture closest to eye. (For entropion, I start medially.)

3) Tie a knot, 2 throws, and cut the tags about an inch long; grab them with a hemostat near the end to control them. Move the tags out of your way for the moment.

4) Apply your next simple interrupted; tie a knot, then bring the hemostat/tags over to lie on that 2nd knot; tie another knot, 2 throws, and cut long. Grab 4x tags with hemostat and move aside.

5) Apply your next simple interrupted…and so on, and so on, across your incision. My last tie, I put another knot (total 4 throws) to finalize.

6) I tidy up the bundle of tags by cutting any wayward ones really short and leave a sheaf of tags long and aimed away from lid margin.

7) To remove sutures (I do this earlier than other areas, 7-10d maximum, to reduce granulation/scar), grasp sheaf of tags and traction them toward the start of your incision…snip, lift…snip, lift…along the line. You only have to grab the tags once and “peel” them off as you snip!