Variations of the Pursestring Suture in Skin Cancer Reconstruction

Abstract

We report 3 simple-to-use variations of the PSS technique that have been extremely useful in the management of cutaneous malignancies.

Modification of the Purse-String Closure for Large Defects of the Extremities

“…Placement of sutures at the wound edge to provide enhanced approximation and strength has been reported and allows complete closure of the wound by one procedure. 10 Our new modification of sutures being placed vertically rather than horizontally maintains the benefits of the original procedure and has further advantages. In areas of atrophic skin, the risk of sutures tearing through friable tissue is decreased.…”

Percutaneous Buried Modification of the Purse-String Closure

“…These include, but are not limited to, using absorbable suture and tying a buried knot, 2 using it in combination with a Burow's graft or linear closure, 3 and performing a cuticular variation (runs of suture lying on the skin surface alternating between dermal bites). Though its use had previously been reported in other fields, the value of this technique in dermatologic surgery as a sole means of closure was introduced by Greenbaum and Radonich.…”

“…1,3,4 Since its original description, various modifications have been described. 1 Its robustness, excellent color, texture match, and low complication rate have enhanced the armamentarium of the reconstructive surgeon.…”

The Purse-String Lockdown

“…Since its initial description as a method of partially closing wounds 1,2 there have been numerous modifications and enhancements of the technique in the field of dermasurgery. [3][4][5][6][7][8][9] Most of the descriptions of the technique focus on its uses for closure of various larger defects resulting from Mohs surgery. There is also emphasis on various methods of suture placement, inside, outside, or a combination of inside and outside the wound, to assist with tissue recruitment based on the tissue type and defect location.…”

“…Other enhancements to the closure have included suture type, absorbable versus nonabsorbable suture, and placement of guiding stitches to enhance wound approximation. [3][4][5][6][7][8][9][10] In reviewing the literature, it became clear that a more detailed description of its execution would be of benefit to those less familiar with the technique. The final step, the ''lockdown'' of the stitch, determines the final area of reduction.…”