Round or elliptical lacerations with partial avulsions (figure A) are prone to bulging in the flap during healing (figure B). This effect can be minimized by approximation of the subcutaneous tissue to the base of the flap and careful apposition of the skin layers. Alternatively, small lacerations may be revised by removal of the flap and pedicle (figure C). Large lacerations warrant primary closure and referral to a plastic surgeon for elective Z-plasty.
