Easy closure of Wounds after Surgery: the Purse-String Suture

Take Home Message: For closure of large defects when the skin is tight = try the purse string suture ! (detail in Abstract) (Study from South Korea)

Comments

The purse string suture allows reduction of around 90% of initial defect size; the rest of the defect heals by secondary intention.

It is an option when the skin is tight such as the extremities.

This method is also indicated when grafting is not an option (for example in high surgical risk patients)

Abstract

Background : Dermatologic surgeons have multiple options of closure for skin defects. However, it is challenging to repair large defects or defects in skin where there is limited skin laxity.

Objective : The aim of the study was to evaluate the effectiveness of the purse-string suture as a stand-alone procedure that allows a permanent primary closure of skin defects, especially when other options are not available due to a poor tissue laxity or certain debilitating medical conditions of patients.

Method : In the study, the authors performed the purse-string suture for wound closure following the creation of a surgical defect. Skin defects were located at different anatomical sites including extremities. We used intradermal purse string suture as well as cuticular purse string suture and epidermal purse string suture if necessary. The size of final scars were compared with the that of the original defects and the cosmetic acceptability was assessed.

Results : After the defect closure with the purse string suture, skin puckering and buckling were evident. However, the postoperative folds disappeared within 6 weeks. The wounds healed with excellent cosmetic and functional results where the remaining scars were 90% smaller than the original defects. There were no significant differences in outcome among the purse string suture techniques.

Conclusion : The purse string suture is a rapid and uncomplicated procedure that provides complete closure with excellent clinical outcomes. It can be used safely where there is limited skin laxity such as defects in extremities.

Reference: Regional Congress of Dermatology (RCD) 2016 – Singapore. RCD16-0081 Skin Cancers and Pre-cancers REDISCOVERY OF A PURSE STRING SUTURE PROVIDING PRIMARY CLOSURE FOR SKIN DEFECTS J.W. Choi1, S.Y. Na2, C.H. Huh1 1Seoul National University Bundang Hospital, Dermatology, Seongnam, Republic of Korea 2Gowoonsesang Clinic, Dermatology, Anyang, Republic of Korea