Many years (uh, decades) ago, about midway through my general surgery residency, one of my co-residents and I performed a below-knee amputation on an elderly, diabetic, hypertensive gentleman. In order to minimize operative time, each of us closed one half of the resulting stump. My co-resident used larger-caliber, vertical mattress suture to close his half of the stump, while I, aspiring to a career in plastic surgery, decided to use a "plastic closure" that I hoped would leave the patient with the best scar possible. I employed a layered closure technique using smaller- caliber, dissolvable simple suture in tiny, non-crushing bites designed to create a "kissing," not "scrunched," closure of the surgical wound edges.
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