The purse‐string suture revisited: a useful technique for the closure of cutaneous surgical wounds

Abstract

The purse-string suture provides complete or partial closure of round postoperative skin defects. It is a rapid and simple procedure to perform. Tension placed on the suture uniformly advances the skin from the entire periphery of the wound, resulting in a significant reduction of the defect size and enhancement of hemostasis at the wound edge. The history, modifications of the technique, advantages, and potential complications of the purse-string suture are reviewed. It is not only useful following the removal of nonmelanoma skin cancer but also after the local excision of melanoma. In addition, this technique is especially suitable for the repair of round surgical wounds for patients who are unable to modify their active lifestyles during the week following surgery, individuals concurrently being treated with anticoagulants, antiplatelet agents or both, and people with extensive postoperative defects that would otherwise require either a skin graft or a large cutaneous flap. Typically, the site of the surgical wound following partial or complete closure with the purse-string suture demonstrates excellent long-term cosmetic and functional results.

Delayed closure of complex defects with serial tightening of loop sutures – clinical outcome in 64 consecutive patients

“…Furthermore, it leads to a significant wrinkling of the skin when applied to larger defects. In addition, the original purse string suture is a one‐time procedure which does not take advantage of skin stretching properties as other techniques do . Another commercially available treatment option is Wisebands ® .…”

The Purse-String Lockdown

“…1 In our series of more than 50 patients using this knot-securing technique, we have found increased ease of securing the knot and enhanced tissue recruitment. We have noted that this simple technique prevents approximately 5% to 10% of the slippage associated with securing the knot in our execution of the stitch.…”

Secondary Intention Healing and Purse-String Closures

“…The technique relies on a single suture so failure of the knot or suture could result in dehiscence of the entire wound, but this seems to be infrequent. 26,27 As mentioned above, a single suture may not be long enough to run the entire circumference of a larger defect. While tying the knot, the suture can occasionally break or pull out of the dermis if improperly placed and must be restarted entirely, which can be frustrating.…”