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REPAIR OPTIONS: CHIN
Preferred option when standard side-to-side closure is not possible
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Defects on the chin are usually repaired using either a side-to-side closure, a rotation flap or a transposition flap.1 The size, orientation and exact location of the defect help determine the best closure. For smaller defects, a side-to-side closure is usually possible. With all repairs on the chin, it is best to avoid placing surgical scars across the mental crease. An M-plasty or T-plasty may be utilised to help achieve this goal. If scars will cross the mental crease or mandibular margin, a Z-plasty may be utilised to break the linear scar at that point.
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Single- or double-sided rotation flaps are ideal for medium to large defects located entirely below the mental crease. A transposition flap may be used to close defects on the lateral and inferior chin.
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Test for chin laxity to verify a side-to-side closure is possible. Determine the direction of closure (horizontal versus vertical). Vertical orientation is often better on the central chin, while an oblique continuation of the mental crease can be used on the lateral chin (see Fig. 16.1). Horizontal orientations are sometimes better for defects on the chin adjacent to the mandibular margin.
If the ellipse will cross over the mental crease or mandibular margin, a Z-plasty may be used at the crease or the margin, or an M- or T-plasty (see Fig. 16.2) will allow the scar to stop short of these lines
Incise the ellipse, ensuring the angle of the scalpel is parallel to the hair follicles. Extirpate the ellipse. Undermine in the subcutaneous plane beneath the hair follicles.
After haemostasis is achieved, insert a few absorbable sutures to close the defect.
Insert the superficial sutures.
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