Large Scalp Defect After Skin Cancer Removal
60 yo female with 4.2 x 7.6 cm scalp defect resulting from Mohs surgery of a basal cell carcinoma. Wound could not be initially approximated. Three SUTUREGARD® Devices used to expand tissue over 2 hours. Wound width decreased from 4.2 cm to 2.0cm. Force to close wound reduced from 25.0N to 8.5N. Allowed linear closure with three 3-0 PDS buried sutures and staples. Wound fully healed at two week staple removal.
90 yo female with BCC of the left temporal scalp. 3 stages of MMS resulted in a 2.0-cm-wide × 2.3-cm-long defect. Scalp had minimal laxity, and patient did not want second-intention healing, flap, or graft. SUTUREGARD® Device used to stretch tissue. Single USP 1 nylon retention suture with a 1.0-cm bite size used in conjunction with device. Xeroform dressing (Covidien, Dublin, Ireland) applied under device before use to absorb moisture. Suture was knotted and a dressing applied over the wound. Wound width was 75% smaller. Skin under the device appeared normal. Wound was cleansed, re-anesthetized, and a closure was performed with 4 simple interrupted 4-0 nylon sutures. Excellent wound healing with no complications.
Scalp with Minimal Laxity
45-year-old male with BCC of left side of the frontal scalp. One stage of MMS that resulted in a 1.8-cm-wide × 1.8-cm-long defect. Patient's scalp exhibited minimal laxity, and the patient did not wish to proceed with second-intention healing or a large rotation flap. Two SUTUREGARD® Devices used with 2 USP 2-0 nylon retention sutures and clamps for 45 minutes. Xeroform dressing was applied under the device before use. Wound size decreased from 1.8 cm to 1.2 cm in diameter in 45 minutes (33% reduction). Decrease allowed wound to be closed with 3-0 nylon simple interrupted sutures. Excellent wound healing with no complications.
Lower Leg Wound, Alternative to Graft or Second Intent Healing
81 yo presented with a BCC on the shin. A stage of MMS resulted in a 2.5-cm-wide X 3.7-cm-long defect. The edges of defect could not be approximated, and patient did not want second-intention healing or a large graft. Two SUTUREGARD® Devices used with 2 USP 1 nylon sutures left in place for 90 minutes, after which the defect decreased in size by 32%. Wound was cleansed, re-anesthetized, and closed with 4-0 nylon sutures. Excellent wound healing at 21 days with no complications.