title: An intraoperative skin-stretching device to close wounds in Mohs defects.
abstract: BACKGROUND
  A skin-stretching device takes advantage of the viscoelastic properties of the skin by exerting incremental traction to aid in closing complex wounds.
  
  
  OBJECTIVE
  To evaluate the effectiveness of a skin-stretching device and determine the cosmetic results available when this device is used in Mohs surgery.
  
  
  METHODS
  We applied a skin-stretching device to seven patients, each of whom had a large, complex wound defect following Mohs surgery. All of the patients had basal cell carcinomas. In one patient the carcinoma was on an upper extremity, and in the others the carcinoma was located on broad facial surfaces, including the temple and forehead.
  
  
  RESULTS
  Complete primary closure was accomplished in six patients. A maximum of three cycles of tissue stretching were applied during the period of tissue processing between Mohs layers. In one patient the defect was reduced in size by more than 75%, with final healing by secondary intention. In two patients minor complications developed: focal wound dehiscence occurred in one patient and in the second patient, an inconsequential hypertropic scar developed. In both cases, the problems resolved with acceptable cosmetic results. The remaining patients experienced no complications and the cosmetic results were excellent.
  
  
  CONCLUSIONS
  The skin-stretching device accomplishes effective primary closure of large skin defects by dramatically reducing the size of the defect. It allows a simpler closure where a full-thickness graft or local flap would have otherwise been utilized. The device is convenient to use with minimal complications, reduces operative time, and aids greatly in preserving tissue integrity.
authors.affiliation: Department of Dermatology, Roger Williams Medical Center, Brown University School of Medicine, Providence, Rhode Island, USA.
authors.forename: G M
authors.initials: GM
authors.lastname: Marrero
authors.forename: R G
authors.initials: RG
authors.lastname: Dufresne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000601:surgery*; D005153:Facial Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery / Q000295:instrumentation*; D012878:Skin Neoplasms / Q000601:surgery*; D013536:Suture Techniques / Q000295:instrumentation*; D015625:Tissue Expansion Devices; D014945:Wound Healing / Q000502:physiology