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This is a niche technique used for reducing the appearance of dog ears, or standing cones, at the ends of elliptical excisions or local flaps. While dog-ear minimization is generally accomplished by excising lesions with fusiform incisions, this often extends the length of the wound significantly, which is undesirable. This technique was designed as an approach to mitigate the raised dog-ear appearance of the standing cone while concomitantly avoiding unnecessarily extending the length of the wound.
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Suture Material Choice
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Suture choice is dependent in large part on location, though as always, the smallest gauge suture material appropriate for the anatomic location should be utilized. On the face, where this technique may be used for flap repairs, a 6-0 or 7-0 monofilament nonabsorbable suture is appropriate. On the trunk, extremities, and scalp, a 3-0 or 4-0 nonabsorbable suture material may be used. Fast-absorbing absorbable sutures may also be used, obviating the need for suture removal but increasing the risk of tissue reactivity.
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The needle is inserted into the proximal edge of the incision line adjacent to the dog ear at 90 degrees, with a trajectory running toward the base of the dog ear.
The needle is pulled through adjacent to the base of the dog ear, reloaded, and inserted parallel with the base of the dog ear in an almost horizontal orientation, as would be done for a purse-string suture. As the needle is freed from the tissue with the pickups, the needle is grasped again by the needle driver in an appropriate position to place the next throw.
The needle is then reinserted into the underside of the distal wound edge and exits on the distal edge of the incision line, parallel to the original entry point.
The suture material is then gently tied utilizing an instrument tie (Figures 5-42A, 5-42B, 5-42C, 5-42D, 5-42E, 5-42F, 5-42G, 5-42H).
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