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and forth until proper alignment with the opposite fixed side is obtained. After the
tip of the flap is sutured, the sides of the flap are brought together. Care must be
taken to ensure there is no tension on sutures at the tip of the flap. For wounds
with several stellate flaps, subcuticular sutures should be used to hold the tips of
the flap together. Then, a single suture at the tip will provide good apposition
without further damage. Other interrupted sutures can be placed on the lateral
margins of the wound to provide further support. If the wound has many narrowbased stellate flaps or necrotic flap tips, the wound may be better managed with
excision and simpler repair ( Fig. 110.10 ). Surgical specialty consultation should
be considered in these complex wound repairs.

FIGURE 110.9 The corner stitch. Also called the half-buried horizontal mattress stitch, this
technique allows repair of flap-type lacerations without further compromising blood flow. Place
additional simple interrupted sutures along the sides of the flap if necessary. (From Grisham J.
Wound care. In: Dieckmann RA, Fiser DH, Selbst SM, eds. Illustrated Textbook of Pediatric
Emergency & Critical Care Procedures . St. Louis, MO: Mosby; 1997:676, reprinted with
permission.)