The thin, friable skin of elderly patients can present a special difficulty for laceration repair. If you find yourself pulling through the skin as you try tighten knots, applying steri-strips along the edge of the skin can serve as a fortifying layer to make the repair easier. Technique illustrated below: essentially suture through the steri-strip as if it were the skin itself. An easy technique to make a difficult job easy.

http://www.ncbi.nlm.nih.gov/pubmed/?term=20880653