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Circular Excision and Purse-String Closure for Pediatric Facial Skin Lesions
Aladdin H. Hassanein, MD, MMSc, Javier A. Couto, BS, Arin K. Greene, MD, MMSc.
Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.

Standard resection of pediatric facial skin lesions consists of lenticular excision and linear closure. This one-stage procedure for circular lesions results in a linear scar 2-3 times longer than the diameter of the removed specimen. Circular excision and purse-string closure has been described for infantile hemangiomas to reduce the length of scar. The purpose of this study was to analyze the application of this technique for all types of circular facial skin lesions in the pediatric population.
Records of consecutive pediatric patients with facial skin lesions treated with circular excision and purse-string closure from 2007-2014 were reviewed. Patient age, gender, type of skin lesion, location on the face, and maximal diameter were recorded. Length of follow-up, and number of stages necessary to remove the lesion were analyzed.
Seventy children (74.3% female, 25.7% male) underwent circular excision and purse-string closure for an infantile hemangioma (n=45.7%), pigmented nevus (25.7%), pilomatrixoma (5.7%), pyogenic granuloma (5.7%), Spitz tumor (5.7%), vascular malformation (4.3%), or another type of skin lesion (7.1%). Age at the time of resection was 5.8 ± 4.7 years and mean lesion diameter was 2.0 ± 1.2 cm. Patients required 1.5 (range 1-5) stages for removal; 31.4% underwent more than one operation. No infection or wound dehiscence occurred.
Excision and purse string closure is an effective technique to manage any type of circular skin lesion. It is particularly useful for lesions on the face because it limits the length of a scar in a visible area. A disadvantage of this approach is that approximately one-third of patients benefit from a second procedure to convert the circular scar into a line.

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