The "round block" purse-string suture: a simple method to close skin defects with minimal scarring

Area of Science:

• Surgical Dermatology
• Wound Closure Techniques
• Plastic and Reconstructive Surgery

Background:

• Surgical skin defects present challenges in closure, often leading to significant scarring and requiring complex reconstructive methods.
• Traditional wound closure techniques may not always yield optimal aesthetic or functional outcomes, particularly for difficult or large defects.

Purpose of the Study:

• To evaluate the efficacy and outcomes of a subcuticular purse-string suture technique for closing surgical skin defects.
• To assess the technique's impact on scar reduction, wound healing, and patient satisfaction.

Main Methods:

• A subcuticular purse-string suture using large, nonabsorbable material was employed for skin defect closure in 196 patients over two years.
• Sutures were left in situ for a mean of 5.7 weeks, with defect sizes ranging from 2x2 cm to 8x11 cm.
• Initial distortion and subsequent scar maturation were monitored, along with complication rates such as dehiscence.

Main Results:

• The technique successfully closed 221 skin defects, with initial distortion improving significantly within 2-3 weeks.
• Final scars were consistently shorter than the original defect, with minimal widening observed when larger sutures were used for longer durations.
• A 10.4% complication rate of dehiscence was noted, primarily attributed to poor skin quality or undersized sutures.

Conclusions:

• The subcuticular purse-string suture is a simple, rapid, and cost-effective method for closing challenging surgical skin defects, often avoiding grafts or flaps.
• This technique offers significant scar minimization and facilitates temporary wound closure, potentially aiding subsequent repairs.
• Despite the need for patient education regarding initial distortion and prolonged suture retention, the method generally achieves high patient satisfaction with favorable final results.