Modified purse-string closure for reconstruction of moderate/large surgical defects of the face

BACKGROUND. Large surgical defects of the face can often be difficult to re pair. Extensive adjacent tissue transfer may be necessary and may result in significant scars and possible flap compromise. Often there may be less do nor tissue available than is necessary to achieve closure. The alternative is a split-thickness skin graft, which often has a poor cosmetic outcome wi th poor color march and contour irregularities. OBJECTIVE. A novel approach to closing large surgical defects of the face i s described. This relies on a combination of side-to-side bilateral advance ment and circumferential tissue recruitment utilizing the purse-string sutu re. METHODS. Report of illustrated cases. RESULTS. A 35 x 5.5 cm preauricular cheek defect, which could not be closed primarily side-to-side, was successfully completely closed in a curvilinea r fashion by implementing both side-to-side bilateral advancement and circu mferential tissue recruitment. A 3.8 x 5.5 cm cheek defect and a 6.0 x 8.0 cm temple defect were significantly decreased by using the modified purse-s tring closure. Healing by second intention in these two cases provided an e xcellent cosmetic result. CONCLUSION. The use of the purse-string closure utilizing circumferential t issue recruitment in combination with side-to-side bilateral adjacent tissu e transfer allows seemingly large facial defects to be closed or significan tly reduced in size. Such closure is evident even in cases where poor skin laxity and size of the defect would not appear to allow this. The modified purse string closure can result in an excellent cosmetic outcome.