Cerclage closure is a relatively straightforward approach to wound repair in certain locations. Body regions with no appreciable skin creases or relaxed skin tension lines are good candidates for this technique. Regions with inherently high tension of closure is all directions, such central chest and convex shoulder, heal better with a cerclage scar versus a linear scar. Cerclage scar creates a macular scar of smaller diameter than the length of a comparable linear closure scar. This is aesthetically more appealing. Other locations that are cerclage closure candidates are thighs, upper arms, and back. Central cheek is another candidate for cerclage closures particularly for smaller defects.
Initial cerclage closure can create an intensely puckered wound mound. This puckering can be relaxed with several small excisions of the puckers, softening the appearance. As healing takes place, the wound stretches and relaxes, smoothing the puckers. Most cerclage closures heal flat despite initial mounding. The excisions of puckering at time of closure is based on the surgeon’s judgement.
Patient’s expectations need to be managed appropriately. Initial appearance of cerclage closure is universally worse than a neatly closed wound. But with time, a widened scar that is macular in appearance is always better than a widened linear scar in the recommended areas.