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ODAC Poster Abstract Participant Interview – Navid Malakouti, MD


Navid Malakouti, MD is a PGY-3 Dermatology Resident at Howard University Hospital and Washington, D.C. VA Medical Center. His interests include cosmetic, surgical, and general dermatology.

 1- Your abstract focuses on an alternative closure method for excisions. Is there a reason you decided to focus on this topic?

I was flipping through some books and I noticed that there wasn’t much on how dermal suture placement should be approached. A common argument is that the key sutures should be placed in the center of the fusiform defect because this is the area of highest tension, but this argument isn’t supported with any outcome data.

2- What does the current literature say on this topic?

Believe it or not, there are some creative ways to lay down dermal sutures, including variants of running and mattress sutures. Most of these articles focus on the benefits of strength and speed of closure. As far as I could tell, there aren’t any papers discussing wound tension mitigation during closure as the primary purpose of suture technique.

However, despite not being present in the literature, I think this is something many dermatologists already do in current practice even if they weren’t formally taught this technique. For example, some of these bigger, high-tension defects (think melanoma in-situ on the back), it’s just not practical to put a single stitch in the middle of a gaping wound and expect the tissue to hold itself. Many dermatologists will probably put a suture closer to the apices to approximate the wound a little better and distribute that tension.

3- What have your outcomes been? Have you noticed any differences or changes in surgically outcomes from this?

It’s hard to say if outcomes are truly different, but one thing I can comment on is that by performing this technique, chances of standing cones are virtually eliminated since apices are closed first. Not having to correct a dog ear by elongating a wound has real utility when working around sensitive areas such as the eyes or lips.

4- Do you use this method of closure with all simple excisions or is there a key circumstances when you use this technique?

I use this method on any elliptical excision that would otherwise cause me to wrestle with the suture to keep the knot tied. Skin surgery should be delicate.

5- What is the conclusion you would like our readers to learn from your poster?

Try it! If it doesn’t work then you can always cut it out :).