The TWIZZLER SUTURE TECHNIQUE for High Tensioned Wounds

Its Mohs Monday!

For those dermatology NPs/PAs that do Mohs closures, we all know that scalps and the pretibia area are two anatomic locations that are the most challenging to close due to the inelasticity of the skin and pronounced tension.  

I came across a suture technique in the Dermatology Surgery Journal where it introduces the Twizzler Technique.

This technique uses a form of intraoperative tissue expansion to achieve primary closure of high-tension scalp and pretibia wounds. Often times in these difficult areas, we have to opt to close the wound using a flap, graft, or choose second intention healing. Well, this is a great alternative suture technique you can add to your library to implement for the right patient when attempting to keep things simple with optimal healing.

Watch and download video to understand how to perform it ➡️ http://links.lww.com/DSS/B292 (copy & paste URL into browser if does not automatically open).

Below is the case study used in the journal article and steps the author used to perform it (A through I).

TECHIQUE

In the case study used in the article, here were the steps the author used:

A. 2.4 x 2.6 cm SCC

B. 2.6 x 3.1 cm post Mohs defect

C. Creation of ellipse

D. Running percutaneous sutures placed followed by load cycling

E. Running percutaneous sutures loosened

F. Deep dermal sutures placed and tagged with hemostats

G. Final load cycle. Wound edges are approximated under less tension than earlier load cycles

H. Percutaneous suture fastened at either end with surgeon’s slip knot and deep dermatal sutures are secured

I. The repaired defect at 3 months

CONCLUSION

Based on the findings in the research article,

  • The Twizzler technique can be used to repair small and medium high-tension scalp defects post Mohs.
  • All 50 scalp defects that were selected for the study were repaired successfully with the Twizzler (The average defect width was 2.0 cm).
  • Intraoperative tissue expansion and creep deformation on the scalp is challenging, but possible when performed on the right patient. 
  • The average physician aesthetic rating was 3.71 on a 5-point scale (very good; n = 25).
  • Most patients rated the scars as "near normal skin" on the Patient and Observer Scar Assessment Scale 3.0 ( n = 32). 

I really hope you enjoyed this article and new technique! Thank you Dermatologic Surgery  for providing, always, the most up-to-date surgical dermatology, cutting-edge (no pun intended 😂!), scholarly content to help us provide the best quality of care for our patients!

Resource: Dermatol Surg. 2023 Sep 1;49(9):832-837. doi: 10.1097/DSS.0000000000003861. Epub 2023 Jun 16.

Serving with GRATITUDE,

 

Theresa Talens DNP, FNP-C

P.U.L.S.E. Dermatology & Procedures, Inc.

Where we believe in Precision. Ultimate Care. Leverage. Skills. Excellence.