fig4

Figure 4. A patient with significant lower back skin laxity (A), and suboptimal pre-operative markings (B), resulting in uneven tissue distribution across the closure and an elongated gluteal cleft (C). Note the large discrepancy in incision lengths and how the orientation bars (yellow lines) do not match up. Modification of the pattern to include a gullwing pattern of the upper incision (blue lines) would have likely avoided cleft elongation and transmission of forces towards the midline (blue arrows).