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How does one include sign language in a dialogue?

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If one character is using sign language and lip reading while the other is speaking normally, how do you represent the lines of the former? Quotations with "he signed" attribution or italics? E.g.

"When did you first feel the pain?" asked the doctor.

Two days ago, signed the patient.

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When it comes to actually writing the signer's line, I tend to write them between apostrophes. I find it easier and a little more visually appealing than italics, but still allows the reader to differentiate the two languages. I more commonly save the italicization for internal thoughts.

'I wish I could go to the park.' vs. I wish I could go to the park.

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I think it would make the most sense to use the primary language in quotations, because as the previous answer stated, using too many italics would end up making the literature seem cluttered.

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Yes, italics is exactly how I'd do it. Dean Koontz did that in Watchers, as I recall.

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