title: Delayed closure of complex defects with serial tightening of loop sutures - clinical outcome in 64 consecutive patients.
abstract: BACKGROUND
  Direct wound closure, flaps or grafts are considered to be gold standards for the reconstruction of defects. However, these techniques may not be applicable in all cases, especially for the challenging closure of large defects.
  
  
  OBJECTIVE
  We developed a technique to close large defects, of varying size and shape, using serial tightening loop sutures. In 64 consecutive patients, loop sutures were applied to defects from 3 cm(2) up to 173 cm(2) for a maximum of 42 days with tightening every 2-7 days.
  
  
  RESULTS
  The median size of the defects was 20 cm(2). In 58 patients (91%) the defects were closed by direct approximation of the wound edges within a median time of 11 days (range: 4-42 days). Two patients received a skin transplant after a significant reduction of the defect size and four remaining defects healed by secondary intention. The skin stretching of defects located on the trunk was faster compared with defects on the extremities. Defects located on the scalp were closed hair bearing with little scarring. Overall, aesthetic results were satisfying.
  
  
  CONCLUSIONS
  The use of loop sutures allows the delayed closure of large defects avoiding the need for skin flaps or grafts in most cases.
authors: Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, Germany.
authors: Moritz
authors: M
authors: Felcht
authors: Wolfgang
authors: W
authors: Koenen
authors: Christel
authors: C
authors: Weiss
authors: Kasia
authors: K
authors: Weina
authors: Cyrill
authors: C
authors: Geraud
authors: Jörg
authors: J
authors: Faulhaber
mesh_terms: D006801:Humans; D013537:Sutures; D016896:Treatment Outcome; D014945:Wound Healing; D014947:Wounds and Injuries / Q000601:surgery*