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Comment & Response
October 2015

Patient Contribution to Reconstructive Decision: The Purse-String Closure

Author Affiliations
  • 1Private Practice, Media, Pennsylvania
JAMA Dermatol. 2015;151(10):1142-1143. doi:10.1001/jamadermatol.2015.1573

To the Editor Cutaneous reconstructive choices reflect a decision-requiring algorithm that should permit input from the patient as well as the surgeon. While some parameters considered may be objectively determined by quantitative analysis, others may be subjective, subtle, even emotional, and not so easily evaluated. The excellent study by Joo et al1 and the thoughtful commentary by Maher et al2 compare the efficacy of the purse-string closure vs secondary healing for wounds on the trunk and extremities. Although it is of interest that no statistical difference emerged in scar quality, aesthetic outcome is usually of lesser importance to patients in these locations. What might be of greater concern is healing time and emotional reaction. Healing time is not so simple to evaluate when comparing a wound closed by sutures with a wound allowed to heal by granulation. A granulating wound is considered healed when the defect has completely epithelialzed, but when is a sutured wound healed? Rather than comparing healing time, it would be simpler to compare “care time” by the patient. Whether the sutures in a closed wound (as illustrated in Figure, C1) are removed in 1 or 2 weeks, the patient care time involved to complete secondary-intent healing is clearly greater. Furthermore, from an emotional perspective, many patients would prefer to deal with a smaller or a completely closed defect rather than the originalsize wound from the tumor removal.

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