Placing an Orientation Suture during an Elliptical Excision Procedure is Simple, Efficient, Safe, and may Help Preserve Tissue Integrity

Abstract

<p class=MsoNormalCxSpFirst style=margin-left:0in;mso-add-space:auto; text-align:justify;text-indent:0in;mso-list:l0 level1 lfo1> 1. Abstract <span style=font-size: 10.0pt>An elliptical skin excision is often performed to provide diagnostic information on managing cutaneous disorders. We propose a simple and safe modification of the standard technique by placing an orientation suture in the specimen before it is removed from the skin in order to provide traction and prevent structural damage to the tissue. <span style=font-size: 10.0pt>An elliptical skin excision is often performed as part of an incisional or excisional biopsy to provide diagnostic information for managing cutaneous disorders [1] . In addition to establishing or confirming a diagnosis, an elliptical skin excision can be used to evaluate the effectiveness of therapy, provide a specimen for histological assessment of margins, and offer a surgical cure for numerous cutaneous disorders [2] . <span style=font-size: 10.0pt>Commonly, an elliptical excision is performed after the surgical site has been marked, anesthetized, prepped, and draped [3]. In the standard procedure, lateral margins of the excision are made, the elliptical specimen is grasped at one of its poles with a pair of tissue forceps and the tissue is elevated. The surgeon then separates the specimen from underlying tissues along a horizontal, even plane using a scalpel or sharp tissue scissors [2] . A suture to remind the surgeon of the orientation is often placed after the specimen has been completely removed from the underlying tissue. The specimen is then transferred to the appropriate fixative container and subsequently submitted to pathology. <span style=font-size: 10.0pt>We propose a simple and safe modification of the standard technique by placing the orientation suture in the specimen before it is removed from the skin in order to provide traction during the removal process without compounding structural damage to the tissue.