Acute Caremiddle twist
An 81-year-old woman catches her shin on a tow bar. There is a 6 cm triangular flap of skin over the front of the lower leg, based distally, pink to its tip, with the edges retracted about 1 cm so that they will not meet without tension. Her skin is thin and purpuric; she has taken prednisolone 10 mg daily for polymyalgia rheumatica for two years. The wound is two hours old and clean, and no bone or tendon is exposed. Which one of the following methods of closing this wound is most appropriate?