The deep layers may be approximated in a similar fashion to the scalp. In this area, unrepaired muscle layers are more likely to produce noticeable scars, especially when the facial muscles of expression are involved. The superficial layers may be closed with 6-0 nonabsorbable interrupted suture (nylon, coated nylon, or polypropylene) or tissue adhesive. For deep wound under tension, a buried 5-0 intradermal, absorbable monofilament (e.g., Monocryl) or multifilament (e.g., Dexon or Vicryl) can be used. The epidermal layer can be closed with 6-0 nonabsorbable nylon in a simple, interrupted fashion; with wound closure strips [e.g., Steri-strips (3M Company) or Dermaseal (Personna Medical)] over tincture of benzoin; or with tissue adhesive.1 l6 These alternate methods of closure are especially attractive if the patient is at risk to develop keloids or hypertrophic scars (e.g., people with darkly pigmented skin). Care should be taken in the forehead to approximate the skin tension lines and hairline precisely (Fig,.,, . ., 38-3).
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