Again place successive sutures in the center of the four defects that remain after the first three center sutures have been placed. If the flap is large and gaps still remain between sutures, place additional sutures as needed to close the gaps. This placement helps distribute skin and tension evenly along the suture line and, thus, helps prevent a dog-ear from developing at the base of the flap. Dog-ears are more common if the flap is sutured progressively from tip to base.
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