The Purse‐String Suture in Facial Reconstruction

Abstract

Mohs surgical defects in 26 patients were reconstructed utilizing a purse-string suture and a full-thickness graft. The placement of the purse-string suture decreased the surface area of the wound an average of 53%. A full-thickness graft was then placed in the remaining defect. This technique enabled us to repair large wounds of the facial region with a relatively small full-thickness graft. There were no complications in our series. The resultant areas were cosmetically acceptable and resistant to trauma.

Minimally Invasive Options for Cutaneous Defects: Secondary Intention Healing, Partial Closure, and Skin Grafts

“…This undermining maximizes tissue mobility and may enhance ultimate cosmesis [69,72,73]. Some surgeons advocate more conservative undermining of 0 to 5 mm to avoid disruption of adjacent vessels and preserve perfusion at the wound edges [74].…”

“…Large areas of exposed bone, cartilage, or tendon in the absence of overlying periosteum, perichondrium, or peritenon are relatively avascular and unable to support a graft [89]. In this situation, a purse-string suture can be used to cover small peripherally positioned avascular portions of the defect before grafting [69]. Donor site selection is critical to overall cosmesis and patient satisfaction.…”

“…The basic premise is recruitment of skin from the entire diameter of a wound to diminish the size of the defect. Typically, purse-string closures facilitate size reductions ranging from 53% to 89% [69,70]. Any resultant defect can then be repaired with a fullthickness skin graft or left to heal secondarily (Fig.…”

“…The remaining defect, if any, can be covered with a skin graft or allowed to heal in secondarily. Another variation uses nonabsorbable suture (eg, polypropylene) with removal in 2 to 3 weeks [69]. The suture is started externally, half a centimeter from the wound edge.…”

Novel Stacked Double Purse-String Closure

“…The traditional purse-string suture reduces the size of an oval or round medium-sized skin defect by placing, then tightening, a circumferential intradermal suture. 1 Typically, the subcutis is extensively undermined, and the suture then woven subcutaneously along the entire perimeter of a circular defect. When the suture is cinched and secured, the tissue that has been undermined advances toward the center with resulting decreased wound diameter.…”