=Incisions.=—The incisions in plastic surgery are to be made obliquely into the skin rather than at right angles to the surface, the former permitting of better apposition, and undoubtedly causing less epidermal scar. The incisions include the skin only, except when otherwise stated. =Sutures.=—Sutures should be placed not more than ¼ of an inch apart and be made to include the skin only, unless it is deemed advisable to employ deeper ones to relieve undue traction, which often results in suture scars and ofttimes tissue loss, necessitating further operation. The latter may be obviated by placing every other stitch at greater distance from the free edge of the skin, that is, into the undissected border. Intracutaneous sutures may also be employed, but these are rarely, if ever, necessary if the apposition has been properly accomplished. To relieve tension, harelip pins are also used, as later described. Catgut of such size as would be suitable because of its ready absorption is not to be employed for skin suturing, fine twisted silk or selected horsehair being the best material. Formaldehyd catgut can be used if it is desirable; its fine strands withstand absorption to a greater degree than the ordinary. [Illustration: FIG. 37.—⅝ CIRCLE HAAGEDORN NEEDLES.] [Illustration: FIG. 38.—CRESCENT CURVE HAAGEDORN NEEDLES.] _Needles._—Very fine, flat, round-eye needles, such as Haagedorn’s, Nos. 12 to 15, ½ or ⅝ circle, are the most serviceable in skin work, as they incise the skin in penetrating and leave an elongated slit, which heals readily, rarely leaving a needle scar. The selection of needles, however, must be left to the operator, many preferring the one variety to the other. Split-eye needles are quite convenient, but they break more readily, and while they work best with fine silk, this is more readily withdrawn from the eye at undesirable times. For very delicate work the needles mentioned are the best. _Needle Holders._—Inasmuch as the needles used in plastic operations are very small and fine, proper needle holders must be used. The requisitions are that the jaw be long, narrow, of soft copper, and that they have an automatic lock attachment. Plain needle holders may be used, but at times the locking device is very necessary and saves time. The most serviceable of this class are the Kersten modification of Mathieu, an uncomplicated holder of merit (Fig. 39), and the small Haagedorn, five-inch narrow-jaw holder (Fig. 40), or the holders taking similar needles, as shown in Figs. 41 and 42, known as Pozzi’s and Weber’s modifications, respectively. [Illustration: FIG. 39.—KERSTEN-MATHIEU NEEDLE HOLDER.] [Illustration: FIG. 40.—HAAGEDORN NEEDLE HOLDER.] [Illustration: FIG. 41.—POZZI-HAAGEDORN NEEDLE HOLDER, 5 IN.] [Illustration: FIG. 42.—WEBER-HAAGEDORN NEEDLE HOLDER, 6 IN.] [Illustration: FIG. 43.—NEEDLE WITH SUTURE CARRIER.]