Fig 1 - uploaded by Alessandro Scalise
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The schema of our new technique for correcting a dog ear at the end of a wound. (A) Incision at a 90° angle to the long axis of the existing excision line to create a triangular advancement skin flap downward. As much of the triangular raised flap is removed as the correction requires. (B) The 90° incision created disappears as soon as the skin has been sutured. The steep protrusion of the dog ear disappears without either lengthening the wound or creating new scars. The red arrow shows the direction of the flap advancement used for dog ear removal. A B
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Citations
... 6,7 The most common and simplest way to prevent dogears is a straight line wound extension, but the trade-off for the better contour is a longer scar, with potential for reduced shoulder mobility if the incision extends into the axilla or arm. 1,7,12,14,15 Another common strategy employed is the "hockey stick" incision, which involves extending the shorter side of the wound at an approximately 120 degree angle from the original axis that necessarily causes a longer scar. 7 Lastly, the "fish-tail" incision or "Y closure" and its variations ("tear-drop" incision, "L" scar technique) have been described. ...
Postmastectomy "dog-ears" are cosmetically displeasing, can contribute to a poorly fitting bra, and may cause discomfort for patients. They occur most commonly in patients with high body mass index and/or large breasts and can be challenging to manage. To avoid the lateral dog-ear following simple mastectomy, we describe the M-plasty with the addition of a lipodermal flap. We demonstrate that the addition of a lipodermal flap not only flattens the lateral contour of the chest wall but also facilitates a tension-free closure. This helps reduce wound-healing issues in high-risk patients with multiple comorbidities, high body mass index, and large breast size.
... To correct dog ears, the simplest approach is to do nothing when a spontaneous resolution is expected, further extension of the wound is needed and when immediate removal of dog ear is expected to jeopardize the viability of surrounding tissue [4]. In a previous study, dog-ears with an initial height of 8 mm were left in place to spontaneously regress [5].Furthermore, other surgical procedures to correct dog ears include the hockey stick extension technique [4], M-plasty technique [6,7], inverted triangle technique [8], and 90 • incision technique [9]. The disadvantage of all the mentioned techniques is that they create a longer scar at an angle to the original axis. ...
There are several techniques for the prevention of dog-ear. All of the techniques have their own disadvantages, since mostly they lengthen the wound. The current technique prevents dog ear during inverted-T breast lift and reduction without lengthening the wound or creating tension while closing the wound.
... 41 Dog ear formation is further affected by skin elasticity and tension, surgical technique, tissue dynamics, wound geometry, anatomical location, and surface contour, as well as individual patient characteristics. 3,37,43 Even with identical excision design, patient age, skin quality, and skin damage will dictate the presence or absence of dog ears. 37 ...
... The distal excess portion of the triangular raised flap is excised and tailored to fit exactly. This technique removes the excess tissue without significantly lengthening the scar and improves the contour 43 (Figs. 10-14). ...
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.
... The dog ear thus created because of flap advancement was removed by excising a small Burow's triangle. 8 This excision of Burow's triangle also distributed and decreased the tension at the final suture line. ...
Objective
Exposure of implantable electrical devices may increase morbidity and mortality significantly. Usually superficial infections are conservatively managed whereas invasive infections necessitate complete capsulectomy, sub-pectoral placement or implant exchange. Most commonly inadequate soft tissue coverage, soft tissue thinning and scar dehiscence over the edge of the pacemaker are the primary predisposing event. Multiple local surgical options have been described, however, with all these designs, the final scar still remains over the edge of the pacemaker and continue to have a tendency of thinning out with time. We have described a local skin flap which can be de-epithelialized and partially buried under the skin to increase the thickness over the pacemaker edge, thereby preventing further recurrence.
Methods
Three patients admitted in the Cardiology Department presented with impending exposure (n=2)and exposed implant (n=1) over the edge of pacemaker with superficial infection. Local modified rotation skin flap which was de-epithelialized and partially buried under the skin to increase the thickness over the pacemaker edge was performed under local anaesthesia in all the cases.
Results
Flaps settled well in all patients with no evidence of infection, scar dehiscence and recurrence over a follow-up period of 2 years.
Conclusions
This flap technique is recommended for cases of impending pacemaker exposure resulting due to scar dehiscence over the edge and helps by addressing the predisposing factors at an initial stage. In our experience, this technique also helped to salvage exposed pacemaker with superficial infection. To our bestof knowledge this technique has not been described before in the literature.
... Rhinophyma is a rare, disfiguring disease characterized by a progressive hypertrophy of the soft-tissues of the nose with its increased volume, mainly in the lower half, and often associated to an end-stage of severe acne rosacea [1]. In literature only 18 cases of giant rhinophyma are described [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] (Table 1). ...
... A simple alternative for correcting a dog ear is to extend the skin excision in the same direction. It is preferable to perform a 90° incision at the end of the initial incision and to resect the excess skin or to de-epithelialize the redundant skin, avoiding extending the wound [52,53]. ...
Background:
Abdominoplasty, with or without liposuction, is among the most frequently performed aesthetic procedures. Its main objective is to improve the body contour by means of excising redundant skin and fat tissue. Although abdominoplasty is considered a safe procedure with high satisfaction rates, intraoperative and postoperative complications can become a challenge for the surgical team. The aim of this article is to offer a synopsis of the most common complications arising after abdominoplasty, along with evidence-based guidelines about how to prevent and treat them.
Methods:
A systematic MEDLINE search strategy was designed using appropriate Medical Subject Headings (MeSH) terms, and references were scanned for further relevant articles.
Results:
According to the published case series, local complications are considerably more common than complications with systemic repercussions. Approximately 10% to 20% of patients suffer a local complication following abdominoplasty, while fewer than 1% suffer a systemic complication. Prevention and management strategies are critically discussed for complications including seroma, haematoma, infection, skin necrosis, suture extrusions, hypertrophic scars, neurological symptoms, umbilical anomalies, deep venous thrombosis and pulmonary thromboembolism, respiratory distress, and death.
Conclusions:
The complications of abdominoplasty vary in severity and in the impact they have on the aesthetic outcomes. Recommendations for prevention and management are based on various levels of evidence, with a risk of observer bias. However, most complications can be treated appropriately following the current standards, with satisfactory results.
... Other approaches to dog ears include a variety of surgical procedures such as the straight excision with scar lengthening, Burow's triangle, hockey stick and/or right-angle excision, M-plasty, S-plasty, V-Y advancement flap, and triangular advancement flap [5,9]. ...
The closure of any circular or asymmetric wound can result in puckering or an excess of tissue known as a 'dog ear'. Understanding the mechanism of dog ear formation is a fundamental requirement necessary to facilitate an appropriate treatment. Many solutions have been reported in the literature, but in all cases, the correction entails the extension of the scar and the sacrifice of the dermal plexus. Here, we propose a novel technique of dog ear correction by using a three-bite suture that sequentially pierces the deep fascial plane and each dog ear's margin, thus allowing for flattening the dog ear by anchoring the over-projecting tissue to the deep plane. The three-bite technique proved to be a fast, easy, and versatile method of immediate dog ear correction without extending the scar, while maintaining a full and complete local skin blood supply.
Background
Total mastectomy without reconstruction is a commonly adopted procedure for managing breast cancer. Formation of lateral dog ears is very common, especially with large breast cup size. In this study, we assessed the feasibility of adding quilting sutures to the Y plasty technique to achieve more acceptable results in the avoidance of lateral dog ears in comparison to using Y plasty alone.
Methods
The study included 150 female patients with large breast cup size. Patients were randomized 2 : 1 between group A and group B. In group A, 3–5 quilting sutures were added to the lateral flaps of Y plasty. In group B, Y plasty only was adopted without the quilting sutures. Patients were followed up at 4-month intervals for at least 1 year. One year after surgery, patients filled in a questionnaire inquiring about the degree of discomfort in the area beneath the arm. Also, a plastic surgeon was asked to give a score about the cosmetic outcome of managing lateral dog ears both at 3 weeks and 12 months after surgery.
Results
Both groups were comparable in regard to age, BMI, breast cup size, and postoperative radiotherapy exposure. Patients in group A had better scores for satisfaction with the shape of the scar and comfort with the bra. Also, the blinded cosmetic outcome assessment was in favor of group A.
Conclusion
Adding quilting sutures to the lateral flap of the V-Y plasty technique is associated with a better cosmetic outcome in the management of lateral dog ears in mastectomy patients with large breast cup size.
Background:
In 2020, reduction mammoplasties and mastopexies comprised 34.2% of all breast surgeries performed by plastic surgeons. Various approaches for the skin incision of these procedures have been described. The vertical pattern has become an increasingly popular option due to its lower scar burden. However, it is prone to dog-ear formation along the caudal aspect of the incision. Herein, we describe 5 technical steps to eliminate the dog-ear in patients undergoing vertical mammoplasties.
Methods:
A retrospective chart review was performed on all patients who underwent vertical breast reduction and mastopexy between the years 2008 and 2020 performed by the senior author. The 5 steps employed in eliminating the dog-ear are delineated and depicted pictorially.
Results:
A total of 58 patients and 89 breasts were operated upon. A majority of 66.6% were Caucasian, 33.3% were African American, and 1 patient was of Hispanic descent. The mean age was 53.2 years (19-73 years), and average BMI was 31.5 kg/m2 (21.3-42.7 kg/m2). The average resection weights for reduction and mastopexy patients were 479 grams (100-1500 grams) and 58.1 grams (18-100 grams), respectively. Mean follow-up was 10.5 months (1-35 months). Only one patient developed a dog-ear (1.7%) in bilateral breasts (2.2%); however, the patient did not request a revision. Our revision rate over 13 years remained at 0%.
Conclusions:
Utilizing these 5 technical steps reduces the risk of dog-ear deformity and thereby diminishes the overall need for revisional surgery in patients undergoing short scar vertical mammoplasties.
Introduction:
Reconstruction of soft tissue defects after skin cancer excision remains a challenge. Options for reconstruction are numerous, including primary repair, local tissue rearrangement, and skin grafts, among others. In this series, the authors present a novel technique: The triangular dart flap. This is a single-stage tissue rearrangement that uses the redundant tissue of the dog-ear to aid in the closure of these wounds.
Methods:
A retrospective review was conducted of all patients undergoing local tissue rearrangements by the senior author from 2009 to 2018. Factors were collected and analyzed, including age, size and cause of defect, comorbidities, smoking history, and postoperative complications.
Results:
Twenty-four patients underwent reconstruction with a triangular dart flap for repair of malignant defects. Mean defect size was 7.3 cm2 (0.8-20 cm2), and mean repair size was 29.7 cm2 (6-80 cm2). Initial pathology included basal cell carcinoma (45.8%), melanoma in situ (29.2%), and squamous cell carcinoma (16.7%), among others. Location varied widely among face and extremities. Anesthesia was predominantly local only (79.1%). There were no major complications, and 5 (20.8%) minor complications.
Conclusions:
The triangular dart flap is a novel single-stage procedure, generally performed under local anesthesia only, for correction of Mohs defects. By using the redundant tissue of dog-ears to better approximate the wound edges, a tension-free primary closure can be achieved in sensitive areas, such as the nasal tip.
