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The Use of Circular Excisions for Removal of Skin Lesions
Douglas R Dembinski, Laura A Horodyski, Ann R Schwentker
University of Cincinnati College of Medicine
2016-01-31
Presenter: Douglas R Dembinski
Affidavit:
Ann R Schwentker
Director Name: Ann R Schwentker
Author Category: Medical Student
Presentation Category: Basic Science Research
Abstract Category: Aesthetics
Background:
Elliptical excisions with a length-to-width ratio of 3:1 have traditionally been promoted for excision of skin lesions to minimize dog-ears and maximize aesthetic outcome. Anecdotal evidence suggests that a shorter ellipse is often effective, and no scientific evidence on optimal ellipse size was found on literature review. This study was designed to determine whether a circular excision followed by dog-ear excision produced a shorter scar than predicted.
Methods:
39 skin excisions of 10, 15, and 20mm were made on a fresh cadaver. Excisions were then closed primarily without undermining and with simple interrupted suture, in the direction that minimized skin tension. Two researchers measured the length of the final closed wound and dog-ears, if present, and these measurements were averaged.
Results:
13 of 39 (33.3%) excisions were closed without formation of dog ears. Dog-ears were not produced when closing 10 mm wounds in any location. Wounds of up to 20 mm in areas of skin laxity closed primarily without dog-ears. If dog-ears were present, their average length relative to total sutured wound was 40.3% (range 19.3-85.7%).
Conclusion:
Contrary to popular wisdom, all skin excisions could be closed with less than a 3:1 ratio ellipse. The most difficult excisions required an ellipse of 1.8:1, with the average being 1.4:1. Many wounds could be closed with no dog-ears. We suggest a circular excision followed by dog-ear excision to minimize scar length and improve cosmetic outcome.
