S Ciatti1, S S Greenbaum. 1. Skin & Laser Surgery Center of Pennsylvania, Philadelphia, USA.
Abstract
BACKGROUND: Large surgical defects of the face can often be difficult to repair. Extensive adjacent tissue transfer may be necessary and may result in significant scars and possible flap compromise. Often there may be less donor tissue available than is necessary to achieve closure. The alternative is a split-thickness skin graft, which often has a poor cosmetic outcome with poor color match and contour irregularities. OBJECTIVE. A novel approach to closing large surgical defects of the face is described. This relies on a combination of side-to-side bilateral advancement and circumferential tissue recruitment utilizing the purse-string suture. METHODS: Report of illustrated cases. RESULTS: A 3.5 x 5.5 cm preauricular cheek defect, which could not be closed primarily side-to-side, was successfully completely closed in a curvilinear fashion by implementing both side-to-side bilateral advancement and circumferential tissue recruitment. A 3.8 x 5.5 cm cheek defect and a 6.0 x 8.0 cm temple defect were significantly decreased by using the modified purse-string closure. Healing by second intention in these two cases provided an excellent cosmetic result. CONCLUSION: The use of the purse-string closure utilizing circumferential tissue recruitment in combination with side-to-side bilateral adjacent tissue transfer allows seemingly large facial defects to be closed or significantly reduced in size. Such closure is evident even in cases where poor skin laxity and size of the defect would not appear to allow this. The modified purse string closure can result in an excellent cosmetic outcome.
BACKGROUND: Large surgical defects of the face can often be difficult to repair. Extensive adjacent tissue transfer may be necessary and may result in significant scars and possible flap compromise. Often there may be less donor tissue available than is necessary to achieve closure. The alternative is a split-thickness skin graft, which often has a poor cosmetic outcome with poor color match and contour irregularities. OBJECTIVE. A novel approach to closing large surgical defects of the face is described. This relies on a combination of side-to-side bilateral advancement and circumferential tissue recruitment utilizing the purse-string suture. METHODS: Report of illustrated cases. RESULTS: A 3.5 x 5.5 cm preauricular cheek defect, which could not be closed primarily side-to-side, was successfully completely closed in a curvilinear fashion by implementing both side-to-side bilateral advancement and circumferential tissue recruitment. A 3.8 x 5.5 cm cheek defect and a 6.0 x 8.0 cm temple defect were significantly decreased by using the modified purse-string closure. Healing by second intention in these two cases provided an excellent cosmetic result. CONCLUSION: The use of the purse-string closure utilizing circumferential tissue recruitment in combination with side-to-side bilateral adjacent tissue transfer allows seemingly large facial defects to be closed or significantly reduced in size. Such closure is evident even in cases where poor skin laxity and size of the defect would not appear to allow this. The modified purse string closure can result in an excellent cosmetic outcome.
Authors: Paolo Fioramonti; Valentina Sorvillo; Michele Maruccia; Federico Lo Torto; Marco Marcasciano; Diego Ribuffo; Emanuele Cigna Journal: Int Wound J Date: 2018-06-29 Impact factor: 3.315