Simple Flaps and Closures

Home > Reconstruction > Techniques of Reconstruction > Simple Flaps and Closures

Dummy Image

Linear Closure

This is the most straightforward technique of closure of a skin defect. It usually requires additional resection of skin, beyond the necessary margins of excision of a lesion. The resection of skin is done to change the defect shape from a round or an oval into a fusiform shape that can be closed as a line. Sutures are used to bring the deep tissue layers together first, followed by more superficial layers of the skin. Traditional external sutures over the line of closure can be used as a final layer. Sometimes, only internal sutures are required to bring the wound edges together.

 

The advantage of linear closure is control of contour. In areas such as the cheek, flaps can be a disadvantage because they can result in small hills and valleys due to different tension along the flap edges. In a linear closure, contour is easier to control as tension of closure varies along a sraight line in a predictable fashion. The ends of the closure have less tension, while the center has more. The greater the tension along a convex shape, such as the cheek, the greater the flattening of the cheek curve. At the ends of linear closure, an opposite effect occurs - bulging of tissue resulting in a more convex appearance. This is also called standing cone deformity or dog-ear deformity. The bulging of tissues can be exaggerated if the ends of the fusiform closure are not tapered enough. In other words, a 10 degree angle closes with less bulging than a 30 degree angle.

 

To achieve a smaller angle with less bulging, the fusiform excision has to extend further away from the original defect. This creates a longer scar. The balance between contour control and length of scar is the challenge in linear closure. Longer scars have better countour, while shorter scars have a tendency to bulge at the ends. Visual assessment of this balance at the time of reconstruction is hampered by swelling and tension temporarily exaggerated with sutures. Early after linear closure, bulging at ends can be visible but should resolve within 6-10 weeks as the scar and tension dissipate.

Local Flaps

When tissue is removed surgically from the face, such as in skin cancer removal, an open wound (or defect) remains. Reconstruction (or closure) of the defect may be done using a local skin flap.

Related Articles

Skin Cancer Bulletin

The Skin Cancer Bulletin educates members of our community about skin cancer diagnosis, treatment and prevention. We always feature a real patient and their journey through skin cancer removal and reconstruction.
Read More

The Winningest Coach Chooses the Winningest Approach to Skin Cancer

Gary McKnight is the head basketball coach at Mater Dei High School in Santa Ana. At his time there he has become the winningest high school basketball coach in California history. See the video of his story HERE. Coach McKnight has led Mater Dei to more than 1250 victories, including a National Championship and 11…
Read More

America’s Best Dermatologists: We Have Two!

Congratulations to Dr. Adam Aronson and Dr. Alexander Miller for being named America’s Best Dermatologists 2023 by Newsweek. We are honored to have two of our physicians receive this great recognition, and proud of the incredible care they provide to our patients. The list is split by cosmetic and medical dermatologists. In total, 150 cosmetic…
Read More

Anesthesia Anxiety No More

Don’t let the fear of anesthesia hold you back from pursuing surgical procedures. Our patients now have the option for an alternative to general anesthesia known as Gentle Sleep. Instead of deep anesthesia, it induces stage 2 sleep, and when used in combination with other medications, it achieves a comfortable state for patients. We are now…
Read More

Dr. Madorsky speaks to California Dermatologists about Trends in Cosmetic Dermatology

Dr. Simon Madorsky, facial plastic surgeon, addressed an audience of California Dermatologists at the CalDerm Symposium, September 23-25 in Carlsbad. He spoke on Fillers and Nuromuscular Toxins (such as Botox), providing advice and tips for these injectables, as well as explaining relevant facial anatomy. He also spoke to the group about wound repair, including various…
Read More

Chronic Open Wound Management with Wound Vac

Chronic open wounds present a lifestyle challenge for patients. In particular, lower leg wounds can take months to fully heal and may require wound care to prevent infection and maintain a healthy, healing wound.  A wound vac or “vacuum-assisted closure of wound” can expedite healing. A wound vac decreases the air pressure on the wound…
Read More

Stay up to date

Receive research updates, inspiring stories, healthy living tips and more.

WHY CHOOSE SCARS CENTER?

SCARS Center is home to some of the most widely respected dermatologists and plastic and reconstructive surgeons in Orange County.

FOLLOW US

STAY UP TO DATE

Receive research updates, inspiring stories, healthy living tips and more.

Orange County's Premiere Skin Cancer Treatment Center

© 2018 SCARS MANAGEMENT SERVICES. All rights reserved.