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

Reconstructive surgery with an eye for the best aesthetic outcome

It is one thing to accept that you have skin cancer, but it is especially emotional when it is on your face. “How will it change my appearance?” and “Will I have a scar when treatment is done?” are common concerns. Dr. Simon Madorsy, with the support of the SCARS Foundation, has just produced a…
Read More

“I’m balancing my life with better care of me. I need to be around for him.”

Skin cancer isn’t new to this active mother of a seven year old boy. She had her first diagnosis at age 19, followed by three Mohs surgeries to treat basal cell carcinomas. The most dramatic was surgery on her lip, requiring multiple reconstructions performed by Dr. Simon Madorsky. She hoped that this chapter was behind…
Read More

With a Skin Cancer diagnosis, a recording engineer was told he could lose his hearing

A Los Angeles-based music industry professional came to the SCARS Center desperate to preserve his ability to hear. He had been diagnosed with basal cell carcinoma in his ear canal three years earlier, but deferred treatment for professional reasons. Over time, his hearing began to diminish due to the cancerous mass obstructing his ear canal.…
Read More

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.