It is a general rule in facial plastic surgery to sacrifice as little skin as possible. Small wounds that extend obliquely into the tissue should be straightened whenever the surrounding tissue can be mobilized and the wound edges coapted without tension. A subcutaneous suture with a buried knot should always be placed to allow tension-free approximation of the wound margins (see Fig. 2.1). Because the subcutaneous tissue, epidermis, and dermis take different lengths of time to achieve adequate wound strength, early removal of the skin sutures from a wound without subcutaneous sutures would result in a broad, unsightly scar.
< Fig. 2.8 Relaxed skin tension lines (RSTL) and scar revision, front and side views.
a Elliptical excision in the RSTLs.
b Scar excision by W-plasty: The W-plasty is an interdigitat-ing, zigzag-shaped excision with segment lengths of 34 mm.
c Scar excision by the broken-line technique creates skin tags of varying shapes with an edge length of 3-5 mm. The edges interdigitate and should follow the RSTLs as closely as possible.
e The face derives its arterial blood supply from the external carotid artery and anastomotic areas: 1 External carotid artery Facial artery
2.1 Inferior labial artery
2.2 Superior labial artery
2.3 Angular artery Transverse facial artery (from 5) Zygomatico-orbital artery (from 5) Superficial temporal artery
5.1 Frontal branch
5.2 Parietal branch Occipital artery Supraorbital artery Supratrochlear artery Dorsal nasal artery
f The facial nerve and its distribution in the face.
Trunk from the stylomastoid foramen Marginal mandibular branch
2.2 Cervical branch Buccal branches Zygomatic branches Temporal branches Posterior auricular branch
2 + 3: cervicofacial branch
4 + 5: temporofacial branch
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