'To bead or not to bead?'.

In subcuticular wound closure, the use of anchorage beads or knots to maintain opposition of wound edges is a common practice, but can lead to complications. One hundred and one abdominal subcuticular wound closures (44 vertical and 57 transverse) were prospectively studied and assessment of wound swelling was made by measuring the length of exposed suture at both ends of the wound, on successive days postoperatively. Results showed progressive reduction in the exposed suture length. We would suggest that if anchorage beads are used with subcuticular sutures then they should not be pulled tight as postoperative wound swelling will cause the beads to be drawn into the wound often resulting in a troublesome ulcer(s) at the end(s) of the wound.