Waste of skin in elliptical excision biopsy of non-melanomatous skin cancer

Tilleman, Tamara R.; Neumann, Martino; Smeets, N.W.J. Kelleners; Tilleman, Michael M.

doi:10.1080/02844310601011934

Cited by 14 publications

(21 citation statements)

References 9 publications

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“…Clearance rates of 99% for primary tumors and 95% for recurrent tumors have been reported after 5 years 2,3 . Conservation of healthy tissue has always been a matter of interest in dermatologic surgery 4,5 . It is thought that MMS is a tissue‐sparing treatment, based on studies comparing theoretical surgical margins 6,7 .…”

mentioning

confidence: 99%

Randomized Comparison of Mohs Micrographic Surgery and Surgical Excision for Small Nodular Basal Cell Carcinoma

Muller

Dawe

Moseley

et al. 2009

Dermatologic Surgery

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mentioning

confidence: 99%

Randomized Comparison of Mohs Micrographic Surgery and Surgical Excision for Small Nodular Basal Cell Carcinoma

Muller

Dawe

Moseley

et al. 2009

Dermatologic Surgery

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“…Circular skin defects are generally converted to an elliptical shape by adding extra healthy tissue to the flap and closing the flap directly parallel to the wrinkle lines, but direct closure might retract the lower eyelid in the infraorbital region and result in long scars. When an elliptical excision with a mean length:width ratio of 3.13:1.00 and primary closure of the circular defects is performed, the waste of skin ratio has been found to be 130% of the total area of the lesion 11 . Closure of the defect without having to excise additional healthy tissue from the defect or from the raised flaps is important for reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“Reading Man Flap” Design for Reconstruction of Circular Infraorbital and Malar Skin Defects

Seyhan

Çağlar

2008

Dermatologic Surgery

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“…However, in elliptical excisions, healthy skin is wasted and unnecessarily long scars can be created. According to a recent study, compared with the original defect size, a mean of 130% of healthy skin is wasted in this technique [6]. Central depression with peaking at either end of the wound is another problem, and many small flaps have been developed to avoid such unfavorable outcomes.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Aesthetic Results of Small Bilateral V-Y Advancement Flaps in the Extremities and Back

Kim

Choi

Moon

et al. 2017

Arch Aesthetic Plast Surg

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INTRODUCTIONThe most common pattern used for the management of skin tumors or circular skin defects is elliptical excision and closure. This technique is simple and easy, but healthy skin in the corner of the defect is also removed, and it can leave a central depression with dog ears at its ends. Furthermore, these problems are exacerbated when an elliptical excision is performed in a region with insufficient skin redundancy, such as the pretibial region or the heel.Bilateral V-Y advancement flaps have been widely used to reconstruct facial defects [1,2]. These flaps simplify and ease mapping and the operative procedure. Moreover, they show good color and texture harmony because nearby tissue is used. In this technique, triangular flaps based on nutrient pedicles in subcutaneous tissue are usually elevated. Although these random flaps have been proven to have excellent vascularity in the facial region [3,4], repair of the extremities using these flaps has been regarded as more difficult than reconstructions elsewhere in the body because of poor blood supply and the pressure effects of dependency [5]. We performed bilateral V-Y advancement flaps in 24 patients with small Background Random type small V-Y advancement flap is widely used for facial reconstruction with advantages including good color and texture match. However, the flap is not as widely used in the extremities and back as in the face because of apprehension of the relatively poor vascularity as a risk factor of flap necrosis. We used a small bilateral V-Y advancement flap for the repair of extremity and back defects from various causes. Competent clinical outcomes are described. Methods Between 2007 and 2014, 24 patients (48 flaps) with skin defects in the upper or lower extremities and back were enrolled. The site of the defect was on back (n=6), forearm (n=7), upper arm (n=2), lower leg (n=5), thigh (n=3), and axilla (n=1). Results Among the 48 flaps, 47 survived (no event: 42 flaps, total necrosis: 1 flap, partial necrosis: 5 flaps). All partial necrotized flaps healed in 3-4 weeks with conservative care. However, debridement and skin grafting was required for the total necrosis flap. One total necrosis and two partial necroses occurred on the anterolateral side of the lower leg. Two partial necroses occurred on the paraspinal area. Conclusions Contour deformities including central depression and the dog-ear deformity were not observed. Small bilateral V-Y advancement in the extremity and back could be a safe and useful flap, if thick subcutaneous fat and subcutaneous plexus were saved. But areas with thin subcutaneous fat layer, such as the anterolateral lower leg, are poor candidates and carry the increased risk of improper subcutaneous pedicle circulation.

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Waste of skin in elliptical excision biopsy of non-melanomatous skin cancer

Cited by 14 publications

References 9 publications

Randomized Comparison of Mohs Micrographic Surgery and Surgical Excision for Small Nodular Basal Cell Carcinoma

Randomized Comparison of Mohs Micrographic Surgery and Surgical Excision for Small Nodular Basal Cell Carcinoma

“Reading Man Flap” Design for Reconstruction of Circular Infraorbital and Malar Skin Defects

Feasibility and Aesthetic Results of Small Bilateral V-Y Advancement Flaps in the Extremities and Back

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