Methods of reconstructing small skin defects resulting from procedures, such as the removal of a facial cutaneous tumor, include primary closure, local flaps, and skin grafts. Depending on the extent and location of the skin defect, it is often difficult to decide whether to perform primary closure or to use a local flap. As the local flap is usually designed before the skin incision is made, it is frequently larger than required and unnatural postoperative scarring develops. In cosmetic reconstruction, it is important not only to cover the skin defect, but also to reconstruct its color, texture, and shape, and the relaxed skin tension line (RSTL) must also be considered. Designing the local flap only after the skin defect has been sutured as far as possible is advantageous in that a longer portion can coincide with the RSTL, a smaller skin flap can be used, and sutures can be placed unaltered.
