FurnitureLiving RoomDining RoomBedroom Home OfficeKids & TeensNursery Bedroom storage ideasDreaming of more space in your bedroom? It’s time to start getting more creative with your storage. Under the bed is one of the most underused spaces in bedrooms. It is a great place to store rarely used items such as out-of-season clothing. When summer hits, pack away your jumpers and wool socks in a rectangular storage bag and slide it under the bed. These bags, which come in various sizes, also fit well on closet shelves. Those with smaller bedrooms need to use their room’s height. Hanging storage shelves ensure there is no wasted space between the rack and the floor. They can also make it easier to sort and search through clothing. If your room doesn’t have enough closet space, you can take care of your storage needs with a combined wardrobe that has a hanging rack and shelving.Dressers or a chest of drawers both look great and give you more room. An ottoman can also look nice and provide storage.
Put one at the foot of your bed for a sitting space that can also hold linen and other items. Whether it’s a major piece or just a small upgrade, new bedroom furniture and accessories from eBay can give you that extra storage space you need.Compared with running (continuous) sutures, interrupted sutures are easy to place, have greater tensile strength, and have less potential for causing wound edema and impaired cutaneous circulation. Interrupted sutures also allow the surgeon to make adjustments as needed to properly align wound edges as the wound is sutured. Disadvantages of interrupted sutures include the length of time required for their placement and the greater risk of crosshatched marks (ie, train tracks) across the suture line. The risk of crosshatching can be minimized by removing sutures early to prevent the development of suture tracks. Running sutures are useful for long wounds in which wound tension has been minimized with properly placed deep sutures and in which approximation of the wound edges is good.
This type of suture may also be used to secure a split- or full-thickness skin graft. Theoretically, less scarring occurs with running sutures than with interrupted sutures because fewer knots are made with simple running sutures; however, the number of needle insertions remains the same. Advantages of the simple running suture over simple interrupted sutures include quicker placement and more rapid reapproximation of wound edges. Disadvantages include possible crosshatching, the risk of dehiscence if the suture material ruptures, difficulty in making fine adjustments along the suture line, and puckering of the suture line when the stitches are placed in thin skin. Locked sutures have increased tensile strength; therefore, they are useful in wounds under moderate tension or in those requiring additional hemostasis because of oozing from the skin edges. Running locked sutures have an increased risk of impairing the microcirculation surrounding the wound, and they can cause tissue strangulation if placed too tightly.
Therefore, this type of suture should be used only in areas with good vascularization. In particular, the running locked suture may be useful on the scalp or in the postauricular sulcus, especially when additional hemostasis is needed. A vertical mattress suture is especially useful in maximizing wound eversion, reducing dead space, and minimizing tension across the wound. One of the disadvantages of this suture is crosshatching. The risk of crosshatching is greater because of increased tension across the wound and the four entry and exit points of the stitch in the skin. The recommended time for removal of this suture is 5-7 days (before formation of epithelial suture tracks is complete) to reduce the risk of scarring. If the suture must be left in place longer, bolsters may be placed between the suture and the skin to minimize contact. The use of bolsters minimizes strangulation of the tissues when the wound swells in response to postoperative edema. Placing each stitch precisely and taking symmetric bites is especially important with this suture.
The half-buried vertical mattress suture is used in cosmetically important areas such as the face. The pulley suture facilitates greater stretching of the wound edges and is used when additional wound closure strength is desired. The far-near near-far modification of the vertical mattress suture, which basically functions as a pulley suture, is useful when tissue expansion is desired, and it may be used intraoperatively for this purpose. This suture is also useful when one is beginning the closure of a wound that is under significant tension. Placing pulley stitches first allows the wound edges to be approximated, thereby facilitating the placement of buried sutures. When wound closure is complete, the pulley stitches may be either left in place or removed if wound tension has been adequately distributed after placement of the buried and surface sutures. The horizontal mattress suture is useful for wounds under high tension because it provides strength and wound eversion.
This suture may also be used as a stay stitch for temporary approximation of wound edges, allowing placement of simple interrupted or subcuticular stitches. The temporary stitches are removed after the tension is evenly distributed across the wound. Horizontal mattress sutures may be left in place for a few days if wound tension persists after placement of the remaining stitches. In areas of extremely high tension at risk for dehiscence, horizontal mattress sutures may be left in place even after removal of the superficial skin sutures. However, they have a high risk of producing suture marks if left in place for longer than 7 days. Horizontal mattress sutures may be placed before a proposed excision as a skin expansion technique to reduce tension. Improved eversion may be achieved with this stitch in wounds without significant tension by using small bites and a fine suture. In addition to the risk of suture marks, horizontal sutures have a high risk of tissue strangulation and wound edge necrosis if tied too tightly.
Taking generous bites, using bolsters, and cinching the suture only as tightly as necessary to approximate the wound edges may decrease the risk, as does removing the sutures as early as possible. Placing sutures at a greater distance from the wound edge facilitates their removal. The half-buried horizontal suture (also referred as the tip stitch or three-point corner stitch) is used primarily to position the corners and tips of flaps and to perform M-plasties and V-Y closures. The corner stitch may provide increased blood flow to flap tips, lowering the risk of necrosis and improving aesthetic outcomes. [3] However, in larger flaps with greater tension, this technique has been reported to position the flap tip deeper than the surrounding tissue, often resulting in a depressed scar. Absorbable buried sutures are used as part of a layered closure in wounds under moderate-to-high tension. Buried sutures provide support to the wound and reduce tension on the wound edges, allowing better epidermal approximation of the wound.
They are also used to eliminate dead space, or they are used as anchor sutures to fix the overlying tissue to the underlying structures. Wounds under significant tension may benefit from the use of a subcutaneous inverted cross-mattress stitch (SICM stitch), which can approximate such wounds relatively easily via a lateral pulley effect. A buried dermal-subdermal suture maximizes wound eversion. It is placed so that the suture is more superficial away from the wound edge. The buried horizontal mattress suture is used to eliminate dead space, reduce the size of a defect, or reduce tension across wounds. The running horizontal mattress suture is used for skin eversion. It is useful in areas with a high tendency for inversion, such as the neck. It can also be useful for reducing the spread of facial scars. If the sutures are tied too tightly, tissue strangulation is a risk. Although it is slightly more time-consuming to place, this suture appears to result in smoother and flatter scars than a simple running suture.
[8] A modification of the horizontal running suture with intermittent single loops was recently reported to avoid the characteristic track marks resulting from suture tension while increasing wound eversion. [9] Other modifications include the V-shaped Victory stitch. The running subcuticular suture is valuable in areas where tension is minimal, dead space has been eliminated, and the best possible cosmetic result is desired. [11] Because the epidermis is penetrated only at the beginning and end of the suture line, the subcuticular suture effectively eliminates the risk of crosshatching. The suture does not provide significant wound strength, though it does precisely approximate the wound edges. Therefore, the running subcuticular suture is best reserved for wounds in which the tension has been eliminated with deep sutures, and the wound edges are of approximately equal thicknesses. The running subcutaneous suture is used to close the deep portion of surgical defects under moderate tension.
It is used in place of buried dermal sutures in large wounds when a quick closure is desired. Disadvantages of running subcutaneous sutures include the risk of suture breakage and the formation of dead space beneath the skin surface. Modifications of this suture have been recently described, which reportedly allows for consistent eversion and excellent cosmetic results in challenging high-tension areas. The corset plication technique is used in wounds wider than 4 cm that are under excess tension. It creates natural eversion and better wound edge approximation. This technique eases subsequent placement of intradermal sutures, in that wound diameter and tension are significantly reduced. The strength of the suture relies on inclusion of the septations from the fascial layer beneath the subcutaneous tissue. If tissue ruptured postoperatively, tension would be distributed more broadly. Potential problems include suture breakage and wound distortion. The modified corner stitch allows equal eversion of the flap tip edges and improved aesthetic outcomes.