Round Excisions Lead to Shorter Scars and Better Scar Positioning than Traditional Elliptical Excisions

Seo, Soo Hong; Son, Sang Wook; Kim, Il Hwan

doi:10.1159/000150601

Cited by 12 publications

(10 citation statements)

References 19 publications

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“…Although elliptical excision with a 3:1 length-to-width ratio is widely practiced in surgical practice, this technique may lead to unnecessary waste of normal tissue and longer scars (42). A prospective analysis of 41 patients undergoing elliptical and round excisions closed with dog ear repairs found that the overall wound length was 14% shorter for round excisions, most notably in the trunk, scalp, and other areas with thick skin (43). These findings are supported by additional reports of decreased scar length in punch compared to elliptical excisions (44,45).…”

Section: Wounds Outcomes and Scarringmentioning

confidence: 99%

“…Although traditional elliptical excisions allow for primary closure with minimal risk for dog-ear deformity, the overall tissue loss and final scar length are suboptimal (42). Several other techniques, including round, punch, and staged excisions, may decrease the scar length while maintaining a low risk of dog-ear deformity (42)(43)(44)(45).…”

Section: Wounds Outcomes and Scarringmentioning

confidence: 99%

See 1 more Smart Citation

Dispelling myths in dermatologic surgery

Ghias

Shamloul

Khachemoune

2019

Acta Dermatovenerologica Alpina Pannonica Et Adriatica

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cal edema, warmth, or erythema at the procedural site (4). Risk assessments guide the appropriate use of prophylaxis based on procedural type, location, duration, initial condition, and patient health status (3). High-risk cardiac patients and individuals with prosthetic joints should receive prophylactic antibiotics for procedures that involve infected skin or breaching of the oral mucosa (5). Recent guidelines reported that the risk of infective endocarditis from bacterial exposure during daily activities is greater than the risk associated with specific procedures. The greatest change in prophylaxis guidelines redefined the high-risk population as patients with a history of infective endocarditis, prosthetic valve, cardiac transplant with persistent valvulopathy, prosthetic device repaired in the last 6 months, and congenital heart defect. These modifications eliminate 90% of patients who would receive prophylaxis based on the previous guidelines (3). Antibiotics may also be warranted for surgeries of the lower extremities or groin, wedge excisions of the lip or ear, nasal skin flaps, skin grafts, and severe inflammatory skin disease (6, 7). Numerous studies have demonstrated that antibiotic prophylaxis does not reduce the risk of SSI for uncomplicated dermatologic procedures (8-10). Due to the low risk of infection in dermatologic procedures and increasing rate of antimicrobial resistance, prophylactic antibiotics should be reserved for patient-specific circumstances and for procedures with > 5% risk of SSI.

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Section: Wounds Outcomes and Scarringmentioning

confidence: 99%

Section: Wounds Outcomes and Scarringmentioning

confidence: 99%

Dispelling myths in dermatologic surgery

Ghias

Shamloul

Khachemoune

2019

Acta Dermatovenerologica Alpina Pannonica Et Adriatica

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“…Seo et al [3] reported 14% shorter wounds compared to elliptical excisions and 12% of wounds being closed flat without need for dog ear repair. Twenty-two percent of wounds were closed in a different orientation to the original plan.…”

mentioning

confidence: 99%

Dog ears: change the approach, not just the name

Molajo

2011

Eur J Plast Surg

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Sir, I read Mashhadi et al.'s [1] communication:'Dog Earsinappropriate terminology used to describe wound edges' with interest and curiosity.I agree that calling the resultant raised areas following wound closure 'dog ears' may cause patient distress and dissatisfaction. In the litigious culture in which we practice, we may be leaving ourselves vulnerable to legal action.Rather than simply changing the way we describe the deformity, I would prefer to seek alternative means of avoiding 'dog ear' formation (or 'topped peak'). I have concentrated on skin lesion excision in this instance.During my old-fashioned basic surgical training and in my plastic surgery training, I was taught to plan excision by first defining the boundary of the lesion and the necessary excision margins and then design an appropriate ellipse to enable direct closure whilst minimising excess tissue (dog ear or topped peak) formation.I performed a literature search and discovered two publications which compared elliptical excision and closure with a round excision with the necessary dog ear excision at the primary surgery. Hudson-Peacock et al. [2] showed that by performing circular excision and direct closure, 28% of lesions could be closed flat without the need for dog ear repair, 38% of excisions required one dog ear repair and 34% required two dog ear repairs at time of surgery to achieve a flat closed wound. More significant were the findings that the overall wound lengths were 21% shorter than if a traditional ellipse was used, and in 45% of cases, the wound was closed in a different orientation to the original planned elliptical excision.Seo et al.[3] reported 14% shorter wounds compared to elliptical excisions and 12% of wounds being closed flat without need for dog ear repair. Twenty-two percent of wounds were closed in a different orientation to the original plan.I propose the following approach to skin lesion excision:1. Define the boundaries of the lesion (using magnification). Determine excision margins required.3. Draw an appropriate ellipse but not excise ellipse. 4. Excise the lesion and margins. 5. Attempt closure of the round defect and perform dog ear repair as required.This approach should deal with dog ears, leave a flat and shorter scar and avoid 'chasing of dog ears' associated with traditional wound closure techniques.

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“…The authors concluded that circular excision with dog ear repair, if necessary, could help achieve shorter and better‐oriented scars than traditional elliptical excision 15 . Seo and colleagues published a similar study in 2008 of 41 patients that found 14% shorter wound lengths, 22% with a change in direction, and 12% that did not require any dog ear repairs 16 …”

mentioning

confidence: 99%

“…15 Seo and colleagues published a similar study in 2008 of 41 patients that found 14% shorter wound lengths, 22% with a change in direction, and 12% that did not require any dog ear repairs. 16 A prospective study in 2004 attempted to remove benign-appearing papular nevi from the faces of 36 patients in a circular fashion. Cosmesis was rated as good to excellent in all patients, with only one of the 36 patients developing a dog ear.…”

mentioning

confidence: 99%