LETTER TO THE EDITOR
Dog ears: change the approach, not just the name
Received: 27 November 2010 / Accepted: 2 August 2011 /Published online: 1 September 2011
I read Mashhadi et al.’s communication: ‘Dog Ears—
inappropriate terminology used to describe wound edges’
with interest and curiosity.
I agree that calling the resultant raised areas following
wound closure ‘dog ears’ may cause patient distress and
dissatisfaction. In the litigious culture in which we practice,
we may be leaving ourselves vulnerable to legal action.
Rather than simply changing the way we describe the
deformity, I would prefer to seek alternative means of
avoiding ‘dog ear’ formation (or ‘topped peak’). I have
concentrated on skin lesion excision in this instance.
During my old-fashioned basic surgical training and in
my plastic surgery training, I was taught to plan excision by
first defining the boundary of the lesion and the necessary
excision margins and then design an appropriate ellipse to
enable direct closure whilst minimising excess tissue (dog
ear or topped peak) formation.
I performed a literature search and discovered two
publications which compared elliptical excision and closure
with a round excision with the necessary dog ear excision at
the primary surgery. Hudson-Peacock et al.  showed that
by performing circular excision and direct closure, 28% of
lesions could be closed flat without the need for dog ear
repair, 38% of excisions required one dog ear repair and
34% required two dog ear repairs at time of surgery to
achieve a flat closed wound. More significant were the
findings that the overall wound lengths were 21% shorter
than if a traditional ellipse was used, and in 45% of cases,
the wound was closed in a different orientation to the
original planned elliptical excision.
Seo et al.  reported 14% shorter wounds compared to
elliptical excisions and 12% of wounds being closed flat
without need for dog ear repair. Twenty-two percent of
wounds were closed in a different orientation to the original
I propose the following approach to skin lesion excision:
1. Define the boundaries of the lesion (using magnification).
2. Determine excision margins required.
3. Draw an appropriate ellipse but not excise ellipse.
4. Excise the lesion and margins.
5. Attempt closure of the round defect and perform dog
ear repair as required.
This approach should deal with dog ears, leave a flat and
shorter scar and avoid ‘chasing of dog ears’ associated with
traditional wound closure techniques.
1. Mashhadi SA, Loh CYY (2010) ‘Dog ear’—an inappropriate
terminology to describe wound edges. Eur J Plast Surg 33:381
2. Hudson-Peacock MJ, Lawrence CM (1995) Comparison of wound
closure by means of dog ear repair and elliptical excision. J Am
Acad Dermatol 32(4):627–630
3. Seo SH, Son SW, Kim IH (2008) Round excisions lead to shorter
scars and better scar positioning than traditional elliptical excisions.
A. Molajo (*)
Department of Plastic and Reconstructive Surgery,
Eur J Plast Surg (2012) 35:333