ABSTRACT
This chapter provides the reconstructive surgeon with a set of surgical pearls and techniques that are applicable to closing defects in unique areas of skin. A general set of pearls and concepts to aid the surgeon in achieving optimal results in a variety of reconstructive designs. The perioral tissue swells significantly with manipulation and infiltration of local anesthetic, so the subunits should be outlined with a surgical marking pen prior to the first injection. The dermis and epidermis of the vermilion may be closed with a single layer of suture, and the vertical mattress technique may be used to encourage wound eversion. Scalp defects involving the deep dermis that are surrounded by terminal hair growth will likely benefit from a flap repair to eliminate focal alopecia. A rotation flap is commonly employed and helps to offset the relative inelasticity of skin at this location.
