Underappreciated Utility of the Purse-String Suture in Head and Neck Skin Cancer Defect Reconstruction

Abstract

BACKGROUND The purse-string suture (PSS) is a simple, reversible method for reconstructing skin cancer defects. Its utility may be underappreciated in head and neck reconstructive surgery. OBJECTIVE To evaluate the utility of the PSS as an adjunct to the reconstructive ladder when reconstructing head and neck skin cancer defects. MATERIALS AND METHODS This prospective nonrandomized cohort included 109 consecutive adult patients with head and neck defects resulting from skin cancer resection. The PSS was placed in every patient after resection. Patients were evaluated before and after suture placement, and final reconstructive methods were recorded. RESULTS The PSS resulted in a mean defect area reduction of 77.1% (p < .001) and was used in the final reconstruction in 79 (72.5%) patients. The PSS reduced the number of patients requiring adjacent tissue transfer (11), regional tissue transfer (3), and free tissue transfer (1) by 69.4%, 70%, and 80%, respectively. Fifty patients underwent reconstruction in the operating room. After intraoperative placement of the PSS, it was determined that 22 (44.0%) of these defects could have been reconstructed in the clinic (p = .003). CONCLUSION The PSS dramatically reduces defect size, simplifies reconstructive techniques, and often permits reconstruction to be performed in the clinic rather than the operating room.

Purse‐string suture versus full‐thickness skin graft : An efficacy and safety comparison study

“…Moreover, PSS allows the original defect size reduction, with a decrease quantifiable in 77.1% in a prospective nonrandomized cohort of 109 patients, 1 which was confirmed by a reduction of 73% in our results. This guarantees the possibility of performing, if necessary, an additional minor intervention in order to complete the closure of the surgical breach 1,14 …”

“…To the best of our knowledge, this is the first study that compares the efficacy and usefulness of the two different surgical techniques (PSS vs FTSG) in the closure of surgical defects in nondistensible areas, even if numerous previous studies reported PSS as a useful procedure to reduce the residual surgical area, needing a smaller size skin graft. [1][2][3]12 In our experience, the PSS technique proved to be a quick and easy procedure to close or approximate cutaneous skin defects after NMSC excision. Operative times were significantly reduced compared to those needed for FTSG, without perioperative adverse events and excellent hemostatic control, 13 even if the PSS requires a waiting time before removing the suture greater than FTSG.…”

“…This guarantees the possibility of performing, if necessary, an additional minor intervention in order to complete the closure of the surgical breach. 1,14 So, in our opinion, PSS seems to be more appropriate for fragile patients that cannot hold long surgical sessions, but at the same time do not need fast recovery time. In this context, other minimally invasive treatments could be considered, including radiotherapy, electrochemotherapy.…”

“…Especially, there is the need to find a quick and safe solution to close large surgical breaches located in a non‐distensible area, in elderly patients affected by comorbidities. In this context, the purse‐string suture (PSS) and the full‐thickness skin graft (FTSG) offer different approaches for the closure of considerable circular skin defects 1‐4 . This study aims to assess the PSS efficacy, safety, and velocity, together with the possible achievement of an acceptable aesthetic outcome in high operatory risk patients affected by non‐melanoma skin cancer (NMSC), in comparison with FTSG.…”

“…In this context, the purse-string suture (PSS) and the full-thickness skin graft (FTSG) offer different approaches for the closure of considerable circular skin defects. [1][2][3][4] This study aims to assess the PSS efficacy, safety, and velocity, together with the possible achievement of an acceptable aesthetic outcome in high operatory risk patients affected by non-melanoma skin cancer (NMSC), in comparison with FTSG.…”