Plastic surgery made easy - simple techniques for closing skin defects and improving cosmetic results

Although meticulous technique cannot guarantee a superior cosmetic result when repairing skin wounds or excising skin lesions, a well planned and executed repair reduces the risk of unsatisfactory scarring.

This article discusses sound plastic surgery principles that every doctor operating on the skin can apply. Common suture techniques and simple flap techniques and their indications are also discussed.

Principles of effective wound repair include: good lighting and equipment, atraumatic tissue handling, early repair of traumatic wounds, thorough wound debridement and lavage, avoiding healing by secondary intention, judicious antibiotic prophylaxis, appropriate planning of incisions, carefully executed incisions, avoiding wound repair under tension, layered wound repair, use of appropriate suture size and needle, everted wound edges, use of adjuncts such as skin tapes and soft tissue adhesives, and early suture removal. Useful suture techniques include deep dermal sutures with buried knots, simple interrupted sutures, vertical mattress, horizontal mattress, subcuticular sutures, continuous over-and-over sutures and far-near near-far pulley sutures. Rotation, transposition, advancement and island flaps can be useful to close defects in situations where skin grafting is not possible or desirable.