Undermining in Cutaneous Surgery

BACKGROUND: Benefits, risks, and technical aspects of undermining in cutaneous 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 reconstructions and literature consultation form the basis of this review. RESULTS: Literature review and practical experience indicate that undermining reduces wound closing tension. Pertinent anatomic considerations, benefits, risks, as well as sharp and blunt undermining techniques and regional undermining recommendations are discussed. CONCLUSIONS: 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.