Optimizing Design and Execution of Linear Reconstructions on the Face

BACKGROUND Linear closure (LC) is the most common reconstructive design for cutaneous defects. Successful performance of a LC is dependent on both appropriate surgical planning and technical execution. OBJECTIVE To review the design and execution of LCs on the face. MATERIALS AND METHODS A systematic evaluation of LCs is provided to guide a logical approach for the repair of cutaneous facial defects. RESULTS Reproducibly excellent aesthetic and functional results may be achieved with strategies that reduce incisional tension, preserve free margin position, and restore skin contour. Cosmetic unit borders and relaxed skin tension lines may be used to further camouflage facial scars. A comprehensive knowledge of facial anatomy, biomechanical properties of the skin, and incisional tension vectors facilitates correct preoperative planning and intraoperative technique. CONCLUSION Proper design and execution of LCs allow for enhanced cosmesis and permit the cutaneous surgeon to progress to more technically advanced surgical procedures such as cutaneous flaps.