Suture or graft? Changing trends in melanoma wound closure

The method of wound repair following excision of primary cutaneous malignant melanoma has been assessed in a consecutive series of 256 melanomas of the trunk and limbs between 1972 and 1986. Excision margins of 1, 2 and 3-5 cm were used according to clinical assessment of tumour thickness. Primary closure was the preferred method of wound repair and split skin grafting when it could not be achieved. 30% of wounds were closed primarily between 1972-81, rising to 54% between 1982-86. This change has been partly due to an increase in the number of thin lesions, but also due to improved surgical technique. Simple interrupted suture was used between 1972-81. In 1982 a multilayer subcutaneous and subcuticular prolene suture was introduced as an improved method of direct closure, and led to a reversal in the ratio of grafting to primary closure. This technique is particularly beneficial for wounds with excision margins of 2 and 3 cm. Complication rates have been lower for primary suture (4%) than split skin graft (12%).