How to Optimize Wound Closure in Thin Skin
Cutaneous surgery often is performed in areas of extremely thin skin. Traditionally, wound closure in thin skin is complicated because the skin tears easily and wound breakdown can occur. Consequently, healing becomes a challenge. Our group of dermatologic surgeons has developed a novel effective technique that minimizes these problems, which we present step by step.
Complications
Most outcomes after using this technique are typical of optimized linear surgeries, with reduced scarring and complete wound healing (Figure, D). We seldom see complications but the following are possible:
• Bleeding occurs but rarely; the weeklong wrap likely provides great benefit.
• Infection is rare but does occur occasionally, as in any surgical procedure.
• Breakdown of the entire wound is rare; however, we occasionally see focal necrosis near 1 stitch—or rarely 2 stitches—that does not require intervention, apart from longer use of topical Polysporin or petrolatum alone to maximize healing by secondary intention in those small areas.• Despite simple suture placement far from the edge of the wound, wound inversion is seldom a problem because these taut closures have a tendency to expand slightly due to postoperative swelling.
Practice Implications
Any experienced dermatologic surgeon can perfect this technique for closing a wound in thin skin. Because wound closure in areas of fragile skin frequently is encountered in cutaneous surgery, we hope that utilizing this technique results in an optimal outcome for many patients.
