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Subject: Purse-String Suture Closure
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Surgery tray instruments are listed in Appendix G. Consider adding skin hooks to gently handle the skin flaps. Have at least three fine (mosquito) hemostats to assist with hemostasis while developing large skin flaps.
Suggested suture removal times are listed in Appendix J, and a suggested anesthesia tray that can be used for this procedure is listed in Appendix F. All instruments can be ordered through local surgical supply houses.
Closure of round skin defects that are not amenable to other low-tension closures
Temporary reduction of skin defects during malignancy excision procedures
Reconstruction of postsurgical wounds in elderly patients with loose or thin, sun-damaged skin
Operative defects on the distal legs and feet where there is limited skin laxity
Closures in patients who are unable or unwilling to appropriately limit their level of activity following surgery
Poor skin vascular supply
Diseases causing poor vascular supply to the skin (e.g., atherosclerotic heart disease, diabetes, smoking, collagen vascular disease, prior irradiation, severe anemia, anticoagulation)
History of poor wound healing, hypertrophic scarring, or keloid formation
Presence of cellulitis, bacteremia, or active infection
Pitfall: Using a suture smaller than 2-0 may result in suture breakage with tying or the suture pulling through the dermis before it is time for removal.
PEARL: Minimal undermining of the wound margins is necessary, which may help maximize skin vascularity.
Pain, infection, and bleeding
Nonunion of skin edges
Sensory changes (often subside with time)
Hypertrophic scarring (often resolves spontaneously within 12 months)
Widening of the scar (especially on the scalp)
Exuberant granulation tissue