How to create multiple punctate relaxing incisions: Step 1 (large photo)
After administering general anesthesia, prepare the skin around the lesion for aseptic surgery. Then inject a local long-acting analgesic agent (e.g. bupivacaine) around the wound.
Undermine the skin around the wound. If it is not possible to appose the skin edges after undermining, consider using multiple punctate relaxing incisions.
Begin wound closure with a continuous intradermal suture, using 2-0 or 3-0 absorbable suture material on a swaged cutting needle. If the skin edges do not appose as the suture is tightened (A) or if the suture tightens with tension, make punctate relaxing incisions in the skin adjacent to the wound edges (B) on both sides of the wound. Make the incisions in staggered rows, parallel to the wound edges, which are usually parallel to the long axis of the wound.
Place the first row about 1 cm from the wound edge on both sides. Make the first incisions about 1 cm long, and space them about 0.5 cm apart. Beginning with the second row, stagger each incision in respect to the preceding row. Make additional rows of similar incisions as needed to attain relaxation and skin edge apposition. Usually two rows on either side of the wound are sufficient to attain wound closure.