Undermining in cutaneous surgery

BACKGROUND. Benefits, risks, and technical aspects of undermining in cutane ous surgery are presented and reviewed in order to facilitate the execution of this fundamental task of cutaneous surgery. METHODS. The authors' extensive experience with thousands of cutaneous reco nstructions and literature consultation form the basis of this review. RESULTS. Literature review and practical experience indicate that undermini ng reduces wound closing tension. pertinent anatomic considerations, benefi ts, risks, as well as sharp and blunt undermining techniques and regional u ndermining recommendations are discussed. CONCLUSIONS. It is concluded that judicious undermining, properly performed by surgeons knowledgeable of cutaneous anatomy facilitates the execution a nd enhances cosmesis in cutaneous reconstruction. It is the authors' opinio n that sharp undermining technique is the optimal method for most cutaneous reconstructions.