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Presentation

Advanced Techniques for Optimizing Dermatologic Wound Closure and Scar Reduction

Description

The speaker, a dermatologic surgeon with extensive experience in Mohs and scar management, focused on practical techniques to improve wound closure and reduce scarring. A major theme was using subcuticular Prolene as a strong, long-lasting support suture in high-tension wounds, especially when combined with removal of superficial sutures after about a week and delayed removal of the subcuticular stitch weeks later. This approach, sometimes paired with buttons to offload tension and prevent knot-related scarring, was presented as a way to avoid fish-mouth deformity and Frankenstein-like suture marks while producing thin, clean scars. The talk also covered Z-plasties and geometric advancement flaps as effective methods to break up and camouflage scars, lengthen tight wounds, and improve closure in difficult areas such as the lower leg, shoulder, and foot. The speaker emphasized careful planning, marking, and accepting slightly longer incisions when needed because better scar outcomes often result. Finally, he discussed Steri-Strips as a simple and useful option for very thin or fragile skin, noting that they can provide meaningful support without increasing complications when applied meticulously.

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Conclusions

Subcuticular Prolene, when left in place longer than standard deep absorbable sutures, can better تحمل wound tension and reduce fish-mouth scarring and suture marks.
Using a staged closure strategy with early removal of superficial sutures and delayed removal of subcuticular Prolene can yield thinner, cleaner scars even in high-tension areas.
Knot-burying and button-based external fixation can further reduce skin strangulation and scarring in cosmetically sensitive wounds.
Z-plasty and related geometric flap techniques are effective ways to camouflage scars while also lengthening contracted wounds.
Multiple small Z-plasties can be especially useful in tight, low-elasticity areas such as the lower leg and other difficult closure sites.
Although these advanced closures may look bulky or messy initially, they often heal to better long-term cosmetic results than simpler closure methods.
Steri-Strips can provide a practical alternative or adjunct for very thin, fragile skin, especially in elderly patients, with low complication rates.
The overall message is that thoughtful use of tension-relieving suturing and scar-breaking techniques can improve both function and final appearance in challenging dermatologic surgical repairs.

U055. Dermatologic Surgery Pearls for the Non-Mohs Surgeon. AAD Annual Meeting, March 27–31, 2026, Denver, Colorado.
Leslie A Storey, MD, FAAD; Travis Wayne Blalock, MD, FAAD; Keith Gerard LeBlanc Jr., MD, FAAD; Melissa Shive, MD, MPH, FAAD; Nathan Uebelhoer, DO, FAAD.