TOPOGRAPHY
TOPOGRAPHY
The three-dimensional topography of the wound should also be considered when designing a linear closure.11 Indeed, restoring—or maintaining—the natural contours may be at least as important as repairing a wound with a thin scar.20,21 For wounds over convex surfaces, designing a straight-line fusiform closure may lead to both short- and long-term undesirable outcomes. In the short term, dog-ear formation may be exaggerated over the extremes of convex surfaces, and such standing cones may not be resolved using standard dog-ear correction techniques (see Chapter 19). This is the origin of the “chasing the dog ear” phenomenon that may be seen classically when working on the forehead. In the long term, scar contraction occurs three dimensionally; when lateral scar contraction occurs over a convex surface, this may lead to a clinically apparent depressed scar.11 Several approaches may be used to mitigate this risk, including the S-plasty.22–25