A Systematic Review of Cutaneous Dog Ear Deformity: A Management Algorithm

Abstract

Background: Dog ear, a characteristic bunching up of excess tissue formed during wound closure, is a common unsightly problem in cutaneous surgery. It may present as a cosmetic concern or a source of physical discomfort. Several management techniques have been reported, but it is unclear which approach is the most effective or whether outcomes vary with surgical situations. This report assesses the best practices for dog ear management. Methods: A systematic literature search was performed. All relevant articles written in English and involving human subjects were included. Results: There were 2028 potentially relevant articles, but only 36 articles met the inclusion criteria. These articles were published in multispecialty journals. They included 23 techniques or case report articles, 6 retrospective and prospective studies, but no clinical trial or randomized control trial. Ten major techniques were identified in the literature. No single technique was proved to be superior in the literature. There was no recommended algorithm in the literature. Conclusions: Despite there being no single recommended technique to manage dog ear deformities, there is ample evidence to suggest surgeons avoid a pre-planned elliptical design, use a proper skin-conserving design for excision, and carry out a meticulous suture closure as the first steps to prevent dog ears. We discuss the indications for each of the ten techniques and propose an algorithm for dog ear management. Until further research is performed, multispecialty cutaneous surgeons should familiarize themselves with the discussed techniques to provide patients with the best functional and aesthetic results.

Rhomboid flap: Indications, applications, techniques and results. A comprehensive review

“…Traditionally, rhomboid flaps have been safely used to reconstruct small to moderately sized skin defects [ 2 ]. However, the authors have presented several cases where very large sized defects have been successfully reconstructed with rhomboid flaps [ 1 , 3 ].…”

“…Although rhomboid flap has been found to be very versatile [ 1 ], there are instances in which a different flap design should be considered. The major limitation is in patients with lower body mass index and with less available skin [ 3 ]. This is primarily based on relative lack of tissue adjacent to cutaneous defects.…”

“…Additionally, multiple smaller rhomboid flaps can be considered. Other options such as the keystone flap also exist [ 3 ]. However, the large defect size is a relative contraindication as the authors have published case reports in the literature where very large trunk defects were successfully reconstructed with rhomboid flap design [ 1 , 3 ].…”

“…In these situations, local flaps with the pliability, matching texture and color become the best option. Among such flaps, a rhomboid flap is a versatile option for reconstruction [ 3 ].…”

Avoidance and Correction of Deformities in Body Contouring

“…Small dog ear deformities may be treatable with liposuction alone or by anchoring its margins to the deep fascial plane with suture. 38,39 Larger conical deformities require excision of the dog ear and lengthening of the scar with or without the use of liposuction. 38…”