AN INTRAOPERATIVE SKIN-STRETCHING DEVICE TO CLOSE WOUNDS IN MOHS DEFECTS

BACKGROUND. A skin-stretching device takes advantage of the viscoelast ic properties of the skin by exerting incremental traction to aid in c losing complex wounds. OBJECTIVE. TO evaluate the effectiveness of a s kin-stretching device and determine the cosmetic results available whe n this device is used in Mohs surgery. METHODS. We applied a skin-stre tching device to seven patients, each of whom had a large, complex wou nd defect following Mohs surgery. All of the patients had basal cell c arcinomas. In one patient the carcinoma was on an upper extremity, and in the others the carcinoma was located on broad facial surfaces, inc luding the temple and forehead. RESULTS. Complete primary closure was accomplished in six patients. A maximum of three cycles of tissue stre tching were applied during the period of tissue processing between Moh s layers. In one patient the defect was reduced in size by more than 7 5%, with final healing by secondary intention. In two patients minor c omplications developed: focal wound dehiscence occurred in one patient and in the second patient, an inconsequential hypertrophic scar devel oped. In both cases, the problems resolved with acceptable cosmetic re sults. The remaining patients experienced no complications and the cos metic results were excellent. CONCLUSION. The skin-stretching device a ccomplishes effective primary closure of large skin defects by dramati cally reducing the size of the defect. It allows a simpler closure whe re a full-thickness graft or local flap would have otherwise been util ized. The device is convenient to use with minimal complications, redu ces operative time, and aids greatly in preserving tissue integrity.