Biodynamic Excisional Skin Tension (BEST) Lines for Scalp Reconstruction After Skin Cancer Surgery

Since Langer first observed cleavage lines on skin in 1861, his lines have been the reference point for skin excisional lines while planning surgery. However, areas like the scalp pose a special challenge for wound closures, especially as many of the existing descriptions of skin tension lines seem to have different directional preferences. When wrongly-orientated elliptical incisions are used, this may result in skin grafts and/or may lead to a less than ideal cosmetic result. This chapter looks at the best lines of closure of scalp wounds for excisional surgery after skin cancer. The author hypothesizes that incisional and excisional lines must be considered differently, and that there is a preferred orientation for wound closure-lines on the scalp. Biodynamic Excisional Skin Tension (BEST) lines of the scalp are mapped in this study on the scalp using a computerized digital tensiometer that has been described earlier.