Closure of Wounds Under Tension

REPORT OF A CASE A 38-year-old white woman, with a history of basal cell carcinoma, presented for a routine total-body skin examination. A suspicious pigmented lesion was found on the left posterior aspect of the lower leg. An excisional biopsy specimen demonstrated a malignant melanoma, with a depth of 0.5 mm, Clark level 2. It was decided to excise the tumor definitively, with a 2-cm margin. The right inguinal crease was For editorial comment see p 1257. scrubbed and draped in preparation for possible use as a skin-graft donor site. The excision created a defect 5 cm in width (Fig 1). The skin was widely undermined in the fascial plane, but the wound edges could not easily be approximated with manual pressure. At this point, an intraoperative decision needed to be made on whether to attempt a primary closure, and, if so, how to do it. SOLUTION In this case a horizontal mattress suture, using 3-0 nylon