Min Soo Kim, MD, Jong Ho Cho, MD, PhD The Annals of Thoracic Surgery

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A New Method of Chest Drain Wound Closure Using Knotless Suture Material Min Soo Kim, MD, Jong Ho Cho, MD, PhD The Annals of Thoracic Surgery Volume 103, Issue 1, Pages e93-e95 (January 2017) DOI: 10.1016/j.athoracsur.2016.06.094 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Technique of wound closure using unidirectional knotless suture. (A) After suturing the muscle layer, closure of wound using unidirectional absorbable Stratafix sutures (Ethicon, Somerville, NJ) begins at the end of an incision. Instead of tying the knot, the tip of needle enters through the fixation loop and is tightened. (B) Then, the needle is placed horizontally through the subcutaneous tissue by passing through the opposite sides of the wound exactly same as in the continuous subcutaneous suture technique. The Annals of Thoracic Surgery 2017 103, e93-e95DOI: (10.1016/j.athoracsur.2016.06.094) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Completion of chest tube wound closure. (A) The suture continues around the chest tube until the needle reaches the other end of the incision (B) At the other end of the incision, the tip of needle passes under the skin and comes out through the skin about 1 cm from the edge of the incision. The Annals of Thoracic Surgery 2017 103, e93-e95DOI: (10.1016/j.athoracsur.2016.06.094) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Tube removal. (A) After the chest tube is removed, the secured thread is pulled forward to tighten the suture. Then, the wound is sealed just as with a zipper (B) Finally, leftover thread is cut off and nothing is left over at the scar of the chest tube site. The Annals of Thoracic Surgery 2017 103, e93-e95DOI: (10.1016/j.athoracsur.2016.06.094) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions