Tension‐Relieving Techniques

Tension can be relieved by relaxing and lengthening the skin surrounding these sites with a variety of techniques, including undermining, Z-plasty, multiple relaxing incisions, tensioning sutures, and devices such as tie-over bandages. A Z-plasty transposes two interdigitating flaps of skin to increase skin length along lines of tension while shortening it perpendicularly. Use of multiple relaxing incisions is similar to a free mesh graft, except that some of the local blood supply is maintained along the skin attachment. It should only be used in sites where the underlying tissue is healthy and has a sufficient blood supply. Tensioning sutures rely on the mechanical creep and stress relaxation of local skin to gradually stretch and mobilize the skin surrounding wound edges. Tensioning sutures will damage the skin if pulled too tightly.