title: Guiding sutures to promote optimal contraction of a large surgical defect prior to delayed grafting.
abstract: BACKGROUND
  Large surgical defects on the face are often challenging to repair.
  
  
  OBJECTIVE
  To describe a method to reduce wound area and promote wound contraction.
  
  
  METHODS
  Case report. Mohs' excision of a neglected basal cell carcinoma on the cheek left a large defect of 54 cm2. Delayed grafting was selected for the repair due to the size of the wound and the presence of multiple foci of perineural, muscle and parotid invasion. Two 4-0 polyglactin guiding sutures were placed across the inferior half of the wound; the superior half of the wound was allowed to granulate.
  
  
  RESULTS
  At the time of split-thickness skin grafting 17 days later, the entire wound was 42% smaller than the original defect. The superior half of the wound was reduced by 29%, attributable to granulation. The inferior half of the wound was reduced by 55%, attributable to granulation and the contractile effect of guiding sutures.
  
  
  CONCLUSIONS
  The placement of guiding sutures across large defects is a quick and simple technique that promotes optimal wound contraction with substantial reduction in the size of a wound, improving the final surgical result.
authors.affiliation: Department of Dermatology, University of Iowa, Iowa City, Iowa 52242, USA. hobart-walling@uiowa.edu
authors.forename: Hobart W
authors.initials: HW
authors.lastname: Walling
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Sniezek
authors.forename: Amanda
authors.initials: A
authors.lastname: Friedrichs
authors.forename: Dane R
authors.initials: DR
authors.lastname: Christensen
authors.forename: Duane C
authors.initials: DC
authors.lastname: Whitaker
mesh_terms: D002280:Basal Cell Carcinoma / Q000601:surgery*; D005153:Facial Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D016038:Skin Transplantation; D013524:Surgical Flaps; D013536:Suture Techniques