Comparison of wound closure by means of dog ear repair and elliptical excision

Abstract

Background: Elliptical excision is a standard method of skin tumor removal. The technique commits the operator to the direction and length of wound closure before lesion excision and hence before the shape and size of the resulting defect is known. Objective: This study was designed to compare the predicted results of elliptical excision with those achieved after tumor excision and dog ear repair. Methods: Fifty-one patients with benign and malignant skin tumors were prospectively studied. Each lesion was examined and an optimal ellipse designed and marked on the skin. Only the lesion and the required margin of adjacent skin were excised before the defect was closed in an optimal direction. Dog ears were removed if appropriate. Precise measurements were made at each step. Results: Twenty-eight percent of wounds could be closed with a flat sutured wound without the need for dog ear repair, 38% required one dog ear repair, and 34% two. Overall, the sutured wound length was 21% shorter and the wound direction different from the predicted ellipse in 45% of cases. Conclusion: Excision with dog ear repair results in significantly shorter and potentially better oriented wounds than those achieved by elliptical excision. For excision and closure of skin tumors this technique should be considered as the method of choice.