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One of the basic principles of suturing incisions and lacerations is to evert the skin edges. The tendency for the scar to widen may be minimized and the wound tensile strength may be maximized. To obtain this eversion, the stitch enters the skin at an acute angle to the skin margin, thereby encompassing more tissue deeply rather than superficially. When the knot is tied, the resultant skin edges evert. To affect this maneuver, the surgeon pronates his wrist to an often extreme degree. This can both be uncomfortable and tiring. To minimize this degree of pronation, a number of surgeons remove their fingers from the rings and "palm" the instrument. This technique facilitates the placement of the stitch at an acute "angle" without the necessity for a large degree of pronation, but the value of the rings is lost.
A solution to this problem is a needle holder in which
NOE JM. A New Needle Holder to Facilitate Eversion of the Skin Edges. Arch Surg. 1978;113(2):221. doi:10.1001/archsurg.1978.01370140111027