05/11/2025
Here’s an explanation of the (RTLS) technique:
🧵 Reinforced Tension Line Suture ( ) — Overview
Definition:
A reinforced tension line suture is a skin or fascia closure technique designed to evenly distribute tension across a wound, reduce the risk of dehiscence, and improve cosmetic outcomes. It’s a variation of the tension-relieving or mattress sutures with added reinforcement (often with bolsters, strips, or tapes).
⚙️ Principle
Wound edges under tension (e.g., in scalp, back, or joint areas) are supported by a reinforcing material (such as steri-strips, silicone tubing, or mesh) under the suture loop.
This reinforces the wound margin, preventing the suture from cutting through the skin while maintaining proper eversion and alignment.
🩺 Technique Steps (generalized)
Deep (buried) tension sutures are placed first to reduce wound tension.
Reinforcement material (e.g., small silicone tubing or folded sterile gauze) is positioned on either side of the wound.
A non-absorbable suture (e.g., nylon, polypropylene) is passed through the reinforcement, across the wound, and tied snugly.
This spreads pressure along the reinforced line, minimising ischemia and tissue damage.
🧠 Applications
High-tension closures (shoulder, knee, scalp, back)
Post-oncologic excisions or reconstructive flaps
Areas at risk of dehiscence (fascia)
✅ Advantages
Distributes wound tension effectively
Minimises suture cutting and necrosis
Enhances wound healing and cosmetic results
Useful when tissue advancement is limited
⚠️ Disadvantages / Considerations
Slightly more time-consuming
Requires nonabsorbable materials for removal
Risk of track marks if reinforcement isn’t used properly
