Introduction. Lower extremity excisional wound closures are associated with complications, including infection, delayed wound healing, skin tearing after suture placement, and dehiscence. Use of a novel adhesive suture retention device (ASRD) has previously been shown to support fragile skin under high tension and improve linear closure. Objective. A retrospective analysis of lower extremity excisional wounds was performed to investigate the effect of adopting ASRD on rate of wound closure and adverse events. Materials and Methods. A retrospective chart review from 2 Mohs surgical practices was conducted. The chart review assessed the differences before and after adopting ASRD in linear closure rates, wound healing, and dehiscence rates for lower extremity post-surgical full-thickness wounds of at least 1.0 cm diameter in patients aged 18 years or older. In all cases, the authors shared the same surgical techniques, including limited undermining and use of buried dermal polyglactin sutures. In all ASRD cases, the device was used with 2-0 nylon retention sutures. Results. Adoption of ASRD was associated with a significantly faster time to healing (P < .001). Dehiscence was significantly more commonly seen in the pre-ASRD cohort (24% vs 3%, P = .03). Infection was also more common in the pre-ASRD cohort; however, the difference was not statistically significant (18% vs 3%, P = .09). Conclusions. Utilization of ASRD decreased the incidence of lower extremity wound dehiscence and resulted in faster healing times after Mohs surgery.