Pre-emptive purse-string suture: A novel technique to minimize bleeding risk

SURGICAL CHALLENGE

Providing immediate hemostasis after punch biopsy can be challenging on patients with thrombocytopenia or other coagulopathies.

SOLUTION

We introduce a technique to quickly provide hemostasis and minimize bleeding risk by placing a purse-string suture before performing a punch biopsy. The purse-string suture technique is a simple and quick procedure used to close circular lesions.¹ Under local anesthesia, a continuous, nonabsorbable intradermal suture is placed approximately 1 to 2 mm outside the projected punch biopsy site (Fig 1, A and D). A punch biopsy is then performed inside the perimeter of the previously placed purse-string suture (Fig 1, B and E). The hanging suture ends are immediately tied after the punch biopsy, thereby closing the surgical wound without delay (Fig 1, C and F).

Fig 1.

Use of the pre-emptive purse-string suture technique to minimize bleeding risk. A and D, The lesion is marked and a nonabsorbable intradermal purse-string suture is secured 1 to 2 mm outside the circumference of the defect. B and E, The punch biopsy is performed inside the circumference of the purse-string suture. C and F, The hanging suture strings are then pulled and tied to fully close the excision.

Implementing the purse-string suture before biopsy is ideal for providers practicing without surgical assistants or for patients at risk for heavy or prolonged bleeding after a punch biopsy.¹