The Pulley Stitch

I love the pulley stitch.  The pulley stitch is a "get out of jail free card" for those of us who do a lot of surgery.  It allows the surgeon to put a lot more pull on the skin edges without tearing through the tissue, thus allowing you to close defects under significant tension.  The disadvantage is that it is very likely to leave a significant suture track, but there are times when that is secondary to the integrity of the wound.  One of our players called it a slip stitch, and then described it exactly as I did, above.

The way to tie a pulley stitch is to go near-far-far-near, resulting in that big external loop.  A vertical mattress suture is far-far-near-near, and if under great tension, often strangulates the wound margin.  Not good.  So, if you find yourself struggling to close a wound under tension, consider the pulley stitch.