Undermining and Hemostasis

Undermining and hemostasis are basic surgical techniques that can have a significant impact on surgical outcomes.To review the mechanisms and techniques of undermining and hemostasis, with an emphasis on the advantages and limitations of each modality.The PubMed database was searched for articles with the keywords "undermining," "hemostasis," and "electrosurgery."Whether performing blunt, sharp, or electrosurgical techniques, undermining at the appropriate depth and width is necessary for tissue movement during closures. Both excessive and inadequate undermining can compromise surgical healing. Surgical hemostasis techniques include pressure, suture ligation, topical hemostatic agents, and electrosurgery. Dermatologic surgeons should select the appropriate amount and type of hemostasis for each procedure. Particular care should be taken in performing electrosurgery, given the potential for complications.Understanding and optimizing hemostasis and undermining will allow dermatologic surgeons to execute complex closures with minimal complications.