Circular excision and purse-string closure has been described for infantile haemangiomas as an alternative to lenticular excision. Records of 77 consecutive paediatric patients with facial skin lesions treated with circular excision and purse-string closure from 2007-2014 were reviewed. Lesions excised include infantile haemangioma (46%), pigmented naevus (27%), Spitz naevus (7%), pilomatrixoma (5%), pyogenic granuloma (5%), vascular malformation (4%), or another type of skin lesion (6%). Age at the time of resection was 6.0 years (range four months – 17 years) and mean lesion area was 3.9cm (range 0.2-19.6); 30% of patients underwent a second procedure and no infection or wound dehiscence occurred. The technique involved wide undermining of the surrounding tissues to allow tension free closure, suture with buried dissolvable purse-string sutures, and super cial external dissolvable sutures. The wound was reinforced with cyanoacrylate glue and steristrips and then taped for up to six weeks postop to limit spreading of the scar. The authors mentioned that the scar could later be further improved by either further circular excision and purse-string closure or excision and conversion to a linear scar. The circular scars often resembled a ‘pock mark’. The authors did not recommend using this technique for excision of scalp lesions as there would be a risk of alopecia due to the wide undermining needed. Circular excision and purse-string closure is useful for lesions on the face because it limits the length of a scar and is an alternative to lenticular excision and direct closure. This paper discusses the outcomes of an elegant technique and adds to the literature.

Circular excision and purse-string closure for pediatric facial skin lesions.
Hassanein AH, Couto JA, Greene AK.
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Aina Greig

St Thomas' Hospital, London, UK

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