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It is recommended to add additional simple interrupted sutures.
Sutures can be resorbable or nonresorbable. If resorbable sutures are used, avoid fast resorbable sutures that resorb in less than two weeks, such as the Chromic Gut. When using nonresorbable sutures, they should be taken out 10-14 days post-op.
The sutures do not have any influence on muscle engagement. The flap design and the way it is reflected, together with a lack of releasing incisions, are the factors that prevent muscle engagement.
The flap is the part that should not be connected to the muscles; therefore, the flap is minimally reflected, as explained in the protocols. The sutures are not the issue.