Medical Pearl: Pneumocystis pneumonia prophylaxis for patients on chronic systemic corticosteroids

Abstract

will approximate the skin edges and the surgical assistant can then use a surgical marker to apply lines perpendicular to the line of closure (Fig 2). The skin hooks are then removed, and buried sutures are placed at the corresponding skin markings. This allows for a well-approximated defect (Fig 3) that is ready for superficial sutures or skin adhesive. If superficial sutures are used, the skin markings can be used as a landmark to avoid cutting out the deep sutures with the cutting surface of the suture needle. This method can also be used for side-to-side closure of nonelliptical cutaneous defects, such as might be encountered with Mohs micrographic surgery. Again, skin hooks are used to apply linear tension along the line of proposed closure, skin markings are made, and buried sutures are placed in the center of the defect. Redundant cones of tissue are then removed where necessary, and the remainder of the defect closed. Wounds closed in this fashion may result in significantly shorter and potentially better-oriented scars than those achieved by elliptical excision.