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Case Report/Case Series | The cutting Edge

Barbed Absorbable Suture Closure for Large Mohs Surgery Defect

John Strasswimmer, MD, PhD1,2,3; Ben Latimer, BS1; Hanna Speer1
[+] Author Affiliations
1Advanced Mohs Surgery, Delray Beach, Florida
2Melanoma and Cutaneous Oncology Program, Lynn Regional Cancer Center, Boca Raton, Florida
3Department of Biochemistry, Florida Atlantic University, Boca Raton
JAMA Dermatol. 2013;149(7):853-854. doi:10.1001/jamadermatol.2013.4142.
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Published online

Extract

Section Editor: Edward W. Cowen, MD, MHSc; Assistant Section Editors: Murad Alam, MD; Ruth Ann Vleugels, MD

Article InformationCorresponding Author: John Strasswimmer, MD, PhD, Advanced Mohs Surgery, 2605 W Atlantic Ave, Ste D-204, Delray Beach, FL 33480 (DelrayMohs@mac.com).

Accepted for Publication: March 9, 2013.

Author Contributions:Study concept and design: Strasswimmer.

Acquisition of data: All authors.

Analysis and interpretation of data: All authors.

Drafting of the manuscript: Strasswimmer.

Critical revision of the manuscript for important intellectual content: All authors.

Administrative, technical, and material support: All authors.

Study supervision: Strasswimmer.

Conflict of Interest Disclosures: Dr Strasswimmer serves on the speakers bureau of Angiotech Inc and is a paid speaker for Genentech Inc, DUSA Inc, and Elekta Radiation Therapy Inc.

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Figure.
Closure of Large Surgical Defect With Barbed Suture

A, A large surgical defect following Mohs surgery on the trunk of a patient receiving dual clopidogrel and aspirin anticoagulation. The wound is debeveled but not undermined. The first suture pass is placed in the very deep subcutaneous tissue and brought out within the deep subcutaneous tissue gently until the barbs engage. One arm of the barbed suture is subsequently run in a continuous vertical looping fashion within the deep subcutaneous layer. Each bite of the needle is extended peripherally at least 2.0 cm from the wound edge in order for the points of tension to be lateral to the dermal wound margins (black arrows), thereby minimizing the risk of dermal vasculature strangulation. Traction is placed on the suture parallel to the wound closure in order to close the deepest layer of tissue and allow the barbs to fully engage. The second arm of the suture is passed in a similar pattern, but in the subcutaneous plane, superficial to the first pass, leading to tension-free dermal margin approximation. Minor standing cones are excised, and the remaining closure is accomplished with running polypropylene or other superficial closure material. B, Wound at 8-week follow-up.

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Barbed Sutures for Mohs Surgery

Barbed sutures are a new tool for reconstruction of Mohs and other skin surgery defects. We illustrate the Corseta procedure for closure of defects.

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