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.)