Variations of the pursestring suture in skin cancer reconstruction.

Abstract

The pursestring suture (PSS) utilizes a circumferentially placed intradermal suture to decrease the size of a defect. Its primary application in dermatologic surgery has been to allow placement of a smaller full-thickness skin graft and to enhance secondary intention wound healing. To present our experience with 3 variations of the PSS. The oval defects resulting after surgical excision of cutaneous malignancies were managed with 3 variations of the traditional pursestring technique. These variations included (1) complete closure of the PSS-reduced defect by the placement of traditional interrupted sutures; (2) PSS with the Burow's triangle graft; (3) use of a PSS only part way around an oval defect to avoid distortion of a nearby free margin. In the 7 years of performing these variations of the PSS technique, we have consistently achieved favorable results. We report 3 simple-to-use variations of the PSS technique that have been extremely useful in the management of cutaneous malignancies.