Three Point-Advancement Closure for Skin Defects

Abstract

Background: Circular skin defects are common following Mohs' surgery. Traditional closure (primary, flap, or graft) may involve extensive surgery. Multidirectional advancement closures such as the purse-string closure have been advocated as another useful tool in such cases. Objective: To describe a variation on purse-string closure that, in certain cases, is an excellent alternative to other reconstructions, and will provide good cosmetic and functional outcome. Method: A three-point anchoring suture is placed after undermining to advance the surrounding tissue toward the centre, creating a “Mercedes Benz” or tripod closure following removal of “dog-ears.” Results: Circular wounds in designated areas can be more easily closed, creating well-tolerated, favourable scars. Conclusion: Large wounds may be closed with the advantage of avoidance of larger flaps, of decreased wound healing compared to second intention, and of minimizing removal of healthy tissue. An initial trial of closure with this method does not limit subsequent use of other repairs should it be less than satisfactory.