Cutaneous surgery may witness the involvement of quite thin and fragile skin, most often in elderly patients; and most frequently in the forearms and lower legs locations. Given Dermatologic surgeons frequently encounter these situations, this is a highly practical arena for technical improvements.

In many such patients, there is little meaningful dermis for placement of subcutaneous sutures. Thus, a common approach following surgery, particularly Mohs micrographic surgery in which tumors and defects typically are larger, is healing by secondary intention. Although healing by secondary intention often is a reasonable option, maximizing the use of epidermal skin for primary closure can be an effective means of closing many such defects. Antimicrobial reinforced skin closure strips are effective in wound closure for thin skin. However, earlier efforts involving reinforcement perpendicular to the wound needed more critical details or used a different technique.

A recent study demonstrated a novel effective closure technique that minimizes these problems. This technique has benefitted the wounds of hundreds of patients with satisfying results. The researchers used multiple variations to optimize outcomes, including different sizes of sutures and reinforced skin closure strips, application of medical liquid adhesive, liquid adhesive, and varying postoperative dressings. For three years, they tracked outcomes in-house and gradually agreed to a single, user-friendly paradigm.

They described the procedure as Placing two layers of reinforced skin closure strips—one on top of the other—along each side of the defect, 1 cm away from the wound edges after achieving complete hemostasis. The closure is done by placing multiple pulley sutures and single sutures passing through the reinforced skin closure strips. This is followed by postoperative dressing and leaving the wrap on for one week. After a week, the wound is unwrapped; the reinforced skin closure strips are trimmed back; and the patient is advised to utilize typical wound care at home.

It is advised to Leave sutures in for three weeks for arm procedures and four weeks for leg procedures unless irritation develops or rapid suture overgrowth occurs in either location.

This technique can be performed by any experienced dermatologic surgeon to close a wound in thin skin. Utilizing this technique will result in an optimal outcome for many patients.

Cutis. 2023 January;111(1):43-45. doi:10.12788/cutis.0673