Deep Plane Fixation in Integumental Surgery

Background. Standard wound closure techniques are prone to complication in the presence of tension.
Objective. To show that deep plane fixation (DPF), a surgical modality based on limited undermining and strategic placement of DPF sutures, affects tension-reduced closure in wounds that would otherwise require skin grafts/flaps or tissue expansion.
Methods. The study is based on an analysis of over 2000 scalp operations.
Results. Two groupings of identical sagittal scalp reductions were done. DPF was used in one and not the other. In the series with DPF, reduced tension closure was consistently possible, as was significantly increased excision, relative to the series without DPF.
Conclusions. DPF narrows the wound base and channels tension forces from superficial to deep and/or nonundermined tissues (where they harmlessly dissipate). This allows relatively increased tissue excision and tension-reduced closure.