An intraoperative skin-stretching device to close wounds in Mohs defects

A skin-stretching device takes advantage of the viscoelastic properties of the skin by exerting incremental traction to aid in closing complex wounds.

To evaluate the effectiveness of a skin-stretching device and determine the cosmetic results available when this device is used in Mohs surgery.

We applied a skin-stretching device to seven patients, each of whom had a large, complex wound defect following Mohs surgery. All of the patients had basal cell carcinomas. In one patient the carcinoma was on an upper extremity, and in the others the carcinoma was located on broad facial surfaces, including the temple and forehead.

Complete primary closure was accomplished in six patients. A maximum of three cycles of tissue stretching were applied during the period of tissue processing between Mohs layers. In one patient the defect was reduced in size by more than 75%, with final healing by secondary intention. In two patients minor complications developed: focal wound dehiscence occurred in one patient and in the second patient, an inconsequential hypertropic scar developed. In both cases, the problems resolved with acceptable cosmetic results. The remaining patients experienced no complications and the cosmetic results were excellent.

The skin-stretching device accomplishes effective primary closure of large skin defects by dramatically reducing the size of the defect. It allows a simpler closure where a full-thickness graft or local flap would have otherwise been utilized. The device is convenient to use with minimal complications, reduces operative time, and aids greatly in preserving tissue integrity.