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Texas Two Step

Closing a long-span incision (ie an entire surgical quadrant) can be tedious and time consuming. An efficient technique to close was first introduced by Dan Holtzclaw DDS MS for full arch closure. Dr. Holtzclaw named the technique the Texas Two Step after his hometown of Austin, Texas. The technique includes an initial suture (either a simple interrupted or a horizontal mattress) near the midline of the arch. After the initial knot is tied the tail is left long and a continuous mattress suture is completed to the distal of the quadrant. Upon reaching the end of the incision the needle is returned to the midline via simple continuous sutures to close the incision line. The continuous mattress achieves the benefits of the horizontal mattress noted previously in this chapter but along the entire length of the wound. The simple continuous returning suture seals the incision line and is tied off at the original tail at the midline. This technique achieves watertight closure and can be accomplished with chromic gut sutures. This technique allows full arch closure to be efficient, cost-effective, and require less postoperative time due to the absorbable nature of the suture material. It also allows for great tissue adaptation around multi unit abutments as seen in some of the clinical examples. It is important to ensure that the bites of the continuous mattress portion of the suture are positioned more apical than the followup simple continuous suture bites. In effect, all mattress sutures should be deeper than wound-closure sutures to avoid tension over the incision line.