Direct closure

In direct closure, the wound should be orientated along the dynamic lines to minimize tension on the wound. 

Note: an exception to the rule is the lower lid where closure along the line of Langher can shorten the anteriorlamella leading to ectropion. This problem is especially common if the defect is large and there is lower lid laxity as in the elderly. To avoid this problem, close the defect vertically or if large use skin graft.

A skin defect below the lid

Horizontal closure causes the lower
lid to be pulled down causing 

Vertical closure is preferred


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