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FIGURE 110.5 Placement of a “loop knot” in conjunction with simple sutures of the skin using
an eversion technique. A: The needle enters the skin at a right angle in a way that allows
somewhat less skin and more subcutaneous tissue to be caught in the passage of the needle. The
needle should incorporate the same amount of skin and subcutaneous tissue on each side. The
ideal suture material for placing a “loop knot” is 4-0 nylon. One can also use 5-0 nylon. B: The
first knot should be a surgeon’s knot drawn down gently to barely coapt the skin edges. C: The
second tie should be placed to produce a square knot but should be drawn to produce an
approximate 2- to 3-mm loop. D: The third tie should be placed to produce a square knot. This
third tie can be secured tightly against the second tie, preserving the loop and allowing for some
spontaneous loosening of the surgeon’s knot as later edema develops.