Excisions, Flaps, and GraftsExcisionsBasic Excision Principles- Fusiform excision with length typically three times longer than width; sides of wound should be vertical with a flat, even wound base at the level of subcutaneous fat or fascia
- Excision should always be made parallel to skin tension lines for best cosmetic result
- Skin tension lines: fine wrinkles seen in aged face typically perpendicular to underlying long axis of muscle; lines from tension exerted on skin by facial expression muscles, collagen, and elastic fibers
- Variants of elliptical excision can be used in particular locations for a better cosmetic result:
- S-plasty or lazy S repair: performed if excision over convex surfaces (i.e., jaw, shin, forearm) to ↓ contraction and buckling along length of scar for better cosmetic result
- M-plasty: effective for reducing length of scar when it would encroach on important structures (i.e., corner of mouth, eyebrow)
- Crescent excision: results in shorter curvilinear scar and can be oriented along curved skin tension lines or cosmetic subunit junction lines (i.e., cheek, chin)
- Of note, lesions on the lip with a size equal or less to 1/3 the length of lower lip can be repaired with primary closure after wedge excision due to laxity of the lip
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