Alternative techniques for reduction of scar length during staged excision

Palmieri’s double suture skin repair: a new double suture approach to cases of skin cancer and ulcerative lesions

“…As a matter of fact, we did not find any buried remnants of the epidermal layers or adnexa at histological analysis where the dermal thickness was doubled by the skin suture overlying the ulcerated skin margins whose epidermal layer had previously been scraped out by the blade. This expedient differentiates Palmieri’s suture from those previously described, such as the schematically drawn suture by Fife and Alam [8]. Our technique fulfils the criteria of an easy and quick learning curve and strong effective skin consolidation, which are specifically required in prosthetic breast surgery.…”

Dispelling myths in dermatologic surgery

“…Myth 7: Elliptical excisions for skin tumors optimize wound outcomes and minimize risk of dog-ears. Although elliptical excision with a 3:1 length-to-width ratio is widely practiced in surgical practice, this technique may lead to unnecessary waste of normal tissue and longer scars (42). A prospective analysis of 41 patients undergoing elliptical and round excisions closed with dog ear repairs found that the overall wound length was 14% shorter for round excisions, most notably in the trunk, scalp, and other areas with thick skin (43).…”

“…Alternate methods include: i) the "doughnut," with excision of the central aspect of the lesion that is later sutured to the center; ii) central excision with purse-string closure using a large-caliber suture to cinch along the outer rim; and iii) compressed design to transpose ellipses or half ellipses excised from the lesion. Additional modifications of these techniques may further reduce the final scar length and identify procedural variants that provide better wound outcomes (42).…”

The Biomechanical Properties of the Skin

“…49 Although increased mitotic activity accounts for the true gain in tissue, the biomechanical property of stress relaxation is paramount to the success of PTE. Serial excision is a multistep procedure whereby lesions in inelastic regions can be removed using multiple subtotal excisions.…”

“…At the next excision, more tissue is removed, and the cycle repeats, leading to a gradual expansion. 49 Although increased mitotic activity accounts for the true gain in tissue, the biomechanical property of stress relaxation is paramount to the success of PTE. Stress relaxation is the cause of the initial tissue stretching before the onset of mitotic activity.…”