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Pulley sutures effective for scalp defect reconstructions

Reconstructions of postsurgical scalp defects using a single layer of pulley sutures resulted in significantly reduced closure times and similar scar appearances when compared with bilayered closures, according to study results published in Dermatologic Surgery.

Researchers studied 21 adults (15 men) who had undergone Mohs micrographic surgery to treat nonmelanoma skin cancer, which resulted in scalp defects. Most patients had Fitzpatrick skin types I to II, with ages ranging from late 40s to mid-80s. Criteria included scalp defect size of 1 cm to 8 cm amenable to primary closure.

Patients were randomized to a single-layered closure using pulley sutures (n = 10) or conventional bilayered technique (n = 11), with time measured for each closure. The Patient and Observer Scar Assessment Scale was used measure scar appearance at 2 weeks, 2 months and 6 months after surgery. Visual analog scale was used by a blinded dermatologist to measure before and after photographs.

There were 13 scalp defects at or around the crown, while other locations included the front (n = 3), parietal (n = 3) or occipital (n = 2) regions. The average diameter of scalp defect prior to closure was 1.6 cm, and the average length after closure was 4.8 cm.

There was significantly reduced closure time with the pully technique of 4.6 ± 1.5 minutes compared with an average closure time of 10 ± 1.5 minutes for bilayered closure (P < .001).

“Even though patient overall scores at 2 weeks and observer total score at 6 months were superior in the pulley group, the visual analog scale scores were similar between the two groups,” the researchers wrote.

“Performing a pulley closure is more time-and-cost-effective with matched cosmetic and functional outcomes to conventional closures,” the researchers concluded. “This pulley technique can be safely added to the repertoire of reconstructive modalities for post-surgical scalp defects to increase efficiency and to decrease surgical costs.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.