Volume 4, Issue 9, Pages (October 2018)

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Volume 4, Issue 9, Pages 910-914 (October 2018) The use of a suture retention device with punctureless technique for rapid tissue expansion in facial and lower extremity wounds Allison Stoecker, DO, Stephanie Howerter, DO, John Young, MD, William Lear, MD JAAD Case Reports Volume 4, Issue 9, Pages 910-914 (October 2018) DOI: 10.1016/j.jdcr.2018.09.005 Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 Buried absorbable USP 1 violet PDS suture placed with ends threaded through central holes of the SUTUREGARD device to close 2.8-cm-wide × 3.8-cm-long defect after MMS. USP 1 violet suture was used in this case to highlight the suture path. JAAD Case Reports 2018 4, 910-914DOI: (10.1016/j.jdcr.2018.09.005) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 Suture ends tightened to achieve stress-relaxation and clamped to hold in place on top of SUTUREGARD device. It was tightened incrementally over 45 minutes to allow for direct epidermal approximation. JAAD Case Reports 2018 4, 910-914DOI: (10.1016/j.jdcr.2018.09.005) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 3 The suture retention device was removed. The buried suture stayed in place and was tied. Transient indentation and maceration of the skin resolved by the time the repair was complete. JAAD Case Reports 2018 4, 910-914DOI: (10.1016/j.jdcr.2018.09.005) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 4 SUTUREGARD device with 3-0 PDS and punctureless technique initiated on 3.3-cm-wide × 5.1-cm-long skin defect of the right cheek. JAAD Case Reports 2018 4, 910-914DOI: (10.1016/j.jdcr.2018.09.005) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 5 Right cheek wound after 14 days of healing with minimal erythema and no pressure effect from SUTUREGARD devices. JAAD Case Reports 2018 4, 910-914DOI: (10.1016/j.jdcr.2018.09.005) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 6 The surgeons were unable to approximate the edges of this nearly circular wound. JAAD Case Reports 2018 4, 910-914DOI: (10.1016/j.jdcr.2018.09.005) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 7 Two SUTUREGARD devices placed with 3-0 PDS and punctureless technique to allow for tissue expansion on a 2.4-cm-wide × 2.7-cm-long MMS defect of the left temple. JAAD Case Reports 2018 4, 910-914DOI: (10.1016/j.jdcr.2018.09.005) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 8 Aesthetic linear closure of the surgical defect with 4-0 Monocryl leaves no epidermal puncture wounds. JAAD Case Reports 2018 4, 910-914DOI: (10.1016/j.jdcr.2018.09.005) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions