Dog ears: change the approach, not just the name

Dog ears: change the approach, not just the name Eur J Plast Surg (2012) 35:333 DOI 10.1007/s00238-011-0640-8 LETTER TO THE EDITOR Adeyinka Molajo Received: 27 November 2010 /Accepted: 2 August 2011 /Published online: 1 September 2011 Springer-Verlag 2011 Sir, the wound was closed in a different orientation to the I read Mashhadi et al.’s[1] communication: ‘Dog Ears— original planned elliptical excision. inappropriate terminology used to describe wound edges’ Seo et al. [3] reported 14% shorter wounds compared to with interest and curiosity. elliptical excisions and 12% of wounds being closed flat I agree that calling the resultant raised areas following without need for dog ear repair. Twenty-two percent of wound closure ‘dog ears’ may cause patient distress and wounds were closed in a different orientation to the original dissatisfaction. In the litigious culture in which we practice, plan. we may be leaving ourselves vulnerable to legal action. I propose the following approach to skin lesion excision: Rather than simply changing the way we describe the 1. Define the boundaries of the lesion (using magnification). deformity, I would prefer to seek alternative means of 2. Determine excision margins required. avoiding ‘dog ear’ formation (or ‘topped peak’). I have 3. Draw an appropriate ellipse but not excise ellipse. concentrated on skin lesion excision in this instance. 4. Excise the lesion and margins. During my old-fashioned basic surgical training and in 5. Attempt closure of the round defect and perform dog my plastic surgery training, I was taught to plan excision by ear repair as required. first defining the boundary of the lesion and the necessary This approach should deal with dog ears, leave a flat and excision margins and then design an appropriate ellipse to shorter scar and avoid ‘chasing of dog ears’ associated with enable direct closure whilst minimising excess tissue (dog traditional wound closure techniques. 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 References the primary surgery. Hudson-Peacock et al. [2] showed that by performing circular excision and direct closure, 28% of 1. Mashhadi SA, Loh CYY (2010) ‘Dog ear’—an inappropriate lesions could be closed flat without the need for dog ear terminology to describe wound edges. Eur J Plast Surg 33:381 repair, 38% of excisions required one dog ear repair and 2. Hudson-Peacock MJ, Lawrence CM (1995) Comparison of wound closure by means of dog ear repair and elliptical excision. J Am 34% required two dog ear repairs at time of surgery to Acad Dermatol 32(4):627–630 achieve a flat closed wound. More significant were the 3. Seo SH, Son SW, Kim IH (2008) Round excisions lead to shorter findings that the overall wound lengths were 21% shorter scars and better scar positioning than traditional elliptical excisions. than if a traditional ellipse was used, and in 45% of cases, Dermatology 217(3):276–280 A. Molajo (*) Department of Plastic and Reconstructive Surgery, Whiston Hospital, Liverpool, UK e-mail: European Journal of Plastic Surgery Springer Journals

Dog ears: change the approach, not just the name

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Copyright © 2012 by Springer-Verlag
Medicine & Public Health; Plastic Surgery
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