Mohs surgery update. Intraoperative presuturing

During the course of Mohs surgery, the surgeon may be able to predict that the final closure may require tissue expansion or some other extraordinary measure to close a defect on a particular location. Presuturing, the use of stitches to preoperatively stretch donor tissue peripheral to the wound, has been previously advocated to aid in the primary closure of nonMohs tumor removal defects and scalp reduction defects. We describe the anticipatory need for and the use of button bolstered nonabsorbable sutures to stretch or expand the perioperative tissues for final closure. Previously unreported in the literature, we also employ this technique prior to flap closure. This quick and easy manouever following the intermediate and final stages of Mohs surgery has seen great use in the care of some relatively large tumors.