Undermining in Cutaneous Surgery

Abstract

It is concluded that judicious undermining, properly performed by surgeons knowledgeable of cutaneous anatomy facilitates the execution and enhances cosmesis in cutaneous reconstruction. It is the authors' opinion that sharp undermining technique is the optimal method for most cutaneous reconstructions.

Minimally Invasive Options for Cutaneous Defects: Secondary Intention Healing, Partial Closure, and Skin Grafts

“…The purse-string closure can be facilitated by undermining the defect 5 to 10 mm in all directions within site-appropriate tissue planes [71]. This undermining maximizes tissue mobility and may enhance ultimate cosmesis [69,72,73].…”

A Simple Approach to the S-Plasty in Cutaneous Surgery

“…Next, the skin is widely undermined at the appropriate level, depending on the anatomic site. 4 The initial repair is begun with the placement of a buried vertical mattress suture in the center of the circular defect in a manner that aligns the wound with relaxed skin tension lines ( Figure 1). This maneuver will result in the creation of two standing cones (dogears) at each tip.…”

Rotation Flaps

“…Undermining is very effective in reducing wound closure tension, and, ideally, a properly designed and undermined flap repair is draped over the operative wound under minimal tension. Sharp undermining with a scalpel or Shea undermining scissors under direct visualization is preferred by many surgeons because the flap can be elevated within a uniform and predictable plane 20. When a fascial plane such as the superficial musculoaponeurotic system or muscular plane is encountered, undermining can often be accomplished with great precision using electrosection.…”