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# The Basics Still Matter, 5 Suture Choices, & Upcoming Podcast Release
- URL: https://www.theplasticsfella.com/june-7th/
- Published: 2026-06-05T13:08:27.000Z
- Updated: 2026-06-07T09:36:51.000Z
- Description: Also: Guide to simple interrupted suturing, knot security principles, & 3 recommended reads.
- Author: PlasticsFella
- Tags: thePlasticsPaper

#### In this week's edition

1. ****✍️** [****Letter from** ****P'Fella**](https://www.theplasticsfella.com/june-7th/#a-letter-from-pfella)  
The basics are still the job
2. 🖼️ [****Image of the Week**](https://www.theplasticsfella.com/june-7th/#image-of-the-week)  
Donati vs Allgöwer-Donati sutures
3. ****🚑** [****Technique Tip**](https://www.theplasticsfella.com/june-7th/#technique-tip)  
Simple interrupted suturing
4. 🎓 [****Building in Public**](https://www.theplasticsfella.com/june-7th/#building-in-public)  
What should a great thumbnail look like?
5. 📖 [****What Does the Evidence Say?**](https://www.theplasticsfella.com/june-7th/#what-does-the-evidence-say)  
Square knot vs Granny knot
6. ****🔥** [****Articles of the Week**](https://www.theplasticsfella.com/june-7th/#articles-of-the-week)  
Suture choices, tectonic “sutures”, & staples vs sutures.
7. 💕 [****Feedback**](https://www.theplasticsfella.com/june-7th/#feedback)  
Suggest ideas & give feedback!

## A Letter from P'Fella

**The Basics Are Still The Job*

👋

This week’s issue is really about basic principles. Plastic surgery has a habit of making the interesting part look like the advanced bit: the flap, the plan, the reconstruction, the clever solution. But most of the time, the thing that decides whether a case goes well is much simpler than that. 

It’s tension, tissue handling, blood supply, knowing when to take a smaller bite, when to leave well alone, when a closure is helping, and when it’s making things worse. Those are the bits people like to file under “early training,” but they don’t stay there. They follow you into every bigger case you ever do.

That’s also why we care about the basics so much at P’Fella. The basics are where people build their instincts. If someone really understands the principle, they can adapt when the tissue is friable, swollen, under tension, or just not behaving the way the textbook said it would. If they only know the rule, they’re in trouble the second the case stops looking tidy. Good teaching should help people understand what their hands are actually doing and why it matters.

![Journal on knot tying](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2026/06/Screenshot-2026-06-05-at-18.41.07.png)

Journal on knot tying

I recently came across this [journal on knot tying](https://www.instagram.com/p/DRhsfDpgDQ-/?igsh=MXg5aXo1dW1hMWNxag%3D%3D&ref=theplasticsfella.com) on a slipknot-based “sliputure” that helped standardise closing force and improved knot-force precision in less experienced surgeons. Interesting in itself, but the reason it stood out is because it points back to the same thing: even something as ordinary as knot tension can change perfusion and healing.

So, the takeaway this week is a straightforward one. You do not outgrow the basics. You either keep sharpening them, or they become the weak point in everything else you do. Suturing and knot-tying are a good example of that. People talk about them as if they’re just the final step, the tidy-up at the end. But that's a critical point where judgment shows up, and they matter a lot more than most of us care to admit.

**P’Fella ❤️**

## Image of the Week

**Donati vs Allgöwer-Donati Sutures*

🖼️

****Image of the Week**   
  
This schematic compares the ****classic Donati (vertical mattress)** with the ****Allgöwer-Donati modification**. The Donati vertical mattress provides excellent ****wound edge eversion and tension distribution**, making it useful in high-tension closures. However, the superficial return bite passes through the epidermis, which can lead to ****skin edge strangulation and track marks** if tied tightly.  
  
The Allgöwer-Donati modification addresses this by placing the superficial component ****intradermally rather than transcutaneously**, preserving dermal perfusion while maintaining eversion. The result is ****reduced risk of skin necrosis and improved cosmetic outcomes**, particularly in areas where soft tissue is already compromised.  
  
In trauma, subtle changes in suture technique can significantly influence healing and complication rates.

![Donati vs Allgöwer-Donati Sutures](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2026/06/Schematic-drawings-of-Donati-vertical-mattress-suture-a-and-Allgoewer-Donati-suture-b.png)

Donati vs Allgöwer-Donati Sutures - [Source](https://www.researchgate.net/figure/Schematic-drawings-of-Donati-vertical-mattress-suture-a-and-Allgoewer-Donati-suture-b%5Ffig4%5F333117213?ref=theplasticsfella.com)

## Technique Tip

**Simple Interrupted Suturing*

🚑

****Technique Tip of the Week**  
  
Good suturing is built on fundamentals. This week's video demonstrates the principles of instrument handling, needle control, and consistent tissue approximation that underpin every surgical closure.  
  
A practical tip is to let the ****needle do the work**. Follow the curve of the needle through the tissue rather than forcing it in a straight line, minimising tissue trauma and producing more accurate wound edge approximation.

## Building in Public

**What Should a Great Thumbnail Look Like?*

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2026/06/ChatGPT-Image-Jun-6--2026--08_50_00-PM.png)

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2026/06/ChatGPT-Image-Jun-6--2026--08_55_10-PM.png)

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2026/06/ChatGPT-Image-Jun-6--2026--09_04_59-PM.png)

You have 3 seconds. Which thumbnail would you click on?  
  
As we’re getting ready to release our upcoming podcast season, we want to hear your opinion on something super important: ****the thumbnail**.  
  
A thumbnail is the first thing people see before they ever hear the episode. It has to do a lot of work in a very small space. It should feel intriguing, easy to read, and true to the tone of the show.  
  
We’ve been testing a few visual directions for our upcoming release and we’d love your take 👇

You can now subscribe on [Spotify](https://open.spotify.com/episode/76EpMfATZyXGqXvsfLgIIW?si=Tq%5FoZJHWTU-FH0rEiB1BaA&ref=theplasticsfella.com) to be notified when we go live!

## What Does the Evidence Say?

**Square Knot vs Granny Knot*

In this section, we dive deep into the latest research and evidence on medical practices and surgical techniques. 

For basic wound closure, a majority of surgical evidence supports the ****square knot as the safer default**. Comparative mechanical studies consistently show that ****granny knots are more prone to slippage and premature failure**, whereas square knots are more reliable under load. In experimental testing across multiple suture materials, granny and sliding half-hitch knot****s reduced tensile performance** because of premature loop failure, while square and surgeon’s knots performed better. More recent nylon-based testing also found that square knots outperformed granny knots, although ****surgeon’s knots were strongest overall**, and with very fine ****7-0 nylon**, the difference between knot types became less important.  
  
Additionally, ****knot security is not just about the knot type**. It also depends on ****suture material** and ****throw count**. Studies in commonly used surgical sutures show that knot security varies with ****technique, material, and number of throws**, and is ****not simply fixed by suture size**. In practical terms, ****monofilaments** are less forgiving and usually **need more throws** than braided sutures. Older comparative work also supports why the square knot remains the core teaching knot: it remains the benchmark against which modified knots are judged, even when a surgeon’s knot is chosen to improve initial friction in higher-tension situations.  
  
Sources: ([Lim](https://europepmc.org/article/MED/38595155?ref=theplasticsfella.com), 2024); ([Silver](https://www.joms.org/article/S0278-2391%2816%2900167-1/fulltext?ref=theplasticsfella.com), 2016); ([Muffly](https://pmc.ncbi.nlm.nih.gov/articles/PMC4167833/?ref=theplasticsfella.com), 2014); ([Avoine](https://pmc.ncbi.nlm.nih.gov/articles/PMC4836043/?ref=theplasticsfella.com), 2016)

## Articles of the Week

**3 Interesting Articles with One-Sentence Summaries*

✅

[****Suture Choice and Other Methods of Skin Closure**](https://www.surgical.theclinics.com/article/S0039-6109%2809%2900035-8/abstract?ref=theplasticsfella.com)  
  
The appropriate suture (monofilament vs braided, absorbable vs non-absorbable, barbed vs smooth) directly impacts tensile strength, infection risk, tissue reactivity, and scar quality, making it a key determinant of both healing and long-term aesthetic outcome.

✅

[****Why Tectonic “Sutures” Are Rarely Straight Lines**](https://www.sciencedirect.com/science/article/abs/pii/0040195177900294?ref=theplasticsfella.com)  
  
Rather than a single plate boundary, Tectonic “Sutures” are often a complex, multi-layered zone of deformation with multiple “mini-sutures,” reactivated crust, and distributed strain, making reconstruction of past continental positions far less straightforward than textbook descriptions.

✅

[****Staples vs Sutures: The Infection Risk You Might Be Overlooking**](https://www.bmj.com/content/340/bmj.c1199.abstract?ref=theplasticsfella.com)  
  
This meta-analysis suggests staple closure in orthopaedic surgery may carry a 3-4× higher risk of superficial wound infection compared to sutures (particularly in hip procedures), challenging the assumption that faster closure equals equivalent outcomes.

## Feedback

### I hope you enjoyed it 😄

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