The elliptical punch biopsy: a simple technique

Abstract

We read with interest the articles by Bush et al., 1 Bush J. Ferguson M.W.J. Mason T. et al. The dynamic rotation of Langer's Lines on facia expression. J Plast Reconstr Aesthet Surg. 2006; 60: 393-399 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar , 2 Bush J. Ferguson M.W.J. Mason T. et al. Skin tension or skin compression? Small circular wounds are likely to shrink, not gape. J Plast Reconstr Aesthet Surg. 2008; 61: 529-534 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar as their findings relate directly to a technique we use routinely. The authors determined that the shape of the resultant defect left by a circular punch biopsy was due to the natural lines of tension within the skin. For many years, we have adapted this concept and harnessed the properties of the relaxed skin tension lines (RSTLs) in an alternative way. We stretch the skin perpendicular to the desired orientation of a resultant ellipse (i.e., perpendicular to the RSTLs and parallel to the lines of maximal extensibility (LMEs)) and then use a commercially available circular punch biopsy to excise lesions (Figure 1). Once the excision has been performed, the tension on the skin is released, and the shape of the defect left is an ellipse, oriented along the RSTLs. The resultant wound is then closed with an aesthetic appearance, which remains neat and avoids the potential small dog-ears from closure of a circular wound. In conclusion, this is a simple, yet effective, technique for small skin excisions.