Fascial Plication Sutures: Insights and Potential Applications in Dermatologic Surgery

Fascial plication sutures redistribute closure forces to the deep fascia, offload the dermis and epidermis, decrease dead space, and may reduce complications in high tension dermatologic closures. We summarize technique fundamentals, anatomic indications, and safety considerations informed by plastic surgery literature and early dermatologic reports. Plication is particularly useful for trunk and shoulder defects when layered closure is insufficient, improving stability, scar quality, and seroma risk. Contraindications include contaminated or ischemic wounds, superficial neurovascular structures at risk of entrapment, and very thin patients with limited fascia. Modified approaches, including buried vertical mattress and fascial tensile reduction sutures, have been associated with less scar spread and lower keloid recurrence. Evidence in dermatology remains limited; prospective studies should define patient selection, defect characteristics, and cosmetic and functional outcomes. This research letter offers a practical framework and priorities for evaluation to guide responsible adoption of fascial plication in dermatologic surgery across practice settings.