Various Applications of Purse-String Suture and Its Cosmetic Outcome in Cutaneous Surgical Defects

Abstract

Background: Purse-string suture is a simple technique to reduce wound size and to achieve complete or partial closure of skin defects.

Objective: To classify situations in which purse-string sutures can be utilized and to assess the long-term size reduction and cosmetic outcome of the final scar.

Methods: Patients (93 from Severance hospital and 12 from Gangnam Severance hospital) in whom purse-string sutures were used between January 2015 and December 2019 were retrospectively reviewed. Wound site, final reconstruction method, repair duration, final wound size, and Vancouver scar scale were assessed.

Results: A total of 105 patients were reviewed. Lesions were located on the trunk (48 [45.7%]), limbs (32 [30.5%]), and face (25 [23.8%]). Mean ratio of wound length/primary defect length was 0.79±0.30. Multilayered purse-string suture showed the shortest duration from excision to final repair (p<0.001) and most effectively minimized the scar size (scar to defect size ratio 0.67±0.23, p=0.002). The average Vancouver scar scale measured at the latest follow-up visit at least 6 months postoperatively was 1.62, and the risk of hypertrophic scarring was 8.6%. There was no significant difference in the Vancouver scar scale and the risk of hypertrophic scarring between the different surgical method groups.

Conclusion: Purse-string sutures can be utilized in many stages of reconstruction to effectively reduce scar size without compromising the final cosmetic outcome.

Keywords: Dermatologic surgical procedures; Mohs surgery; Wound closure techniques.

Fig. 1. Typical patient who underwent multilayered purse-string suture only. (A) Initial defect after Mohs surgery. (B) On the day of Mohs surgery, first stage purse-string suture was done. (C) Second stage purse-string suture was done after two weeks. (D) Final scar, three years after surgery.

Fig. 2. (A~D) Typical case of purse-string suture followed by delayed skin graft. (E~H) Typical case of purse-string suture followed by delayed local flap.

Fig. 3. Typical case of wound closure with purse-string suture followed by delayed primary repair. (A) Initial defect after Mohs surgery. (B) Purse-string suture was used to reduce the defect size. (C) One week after initial purse-string suture, complete closure with simple suture was done. (D) Final scar, one year after surgery.