- Christian L Baum, MD
Christian L Baum, MD
- Assistant Professor, Department of Dermatology
- Mayo Clinic
The design and execution of a fusiform ellipse are fundamental skills of skin surgery. The purpose of this procedure is to remove a skin specimen and in the process produce a cosmetically acceptable linear scar. Although the nomenclature for the procedure may vary depending upon the design (eg, elliptical, fusiform, tangent-to-circle), the purpose remains the same.
Since the design of most skin excisions involves sharp, not blunt, points at each end, the most appropriate description of this design is either fusiform or tangent-to-circle, and not elliptical (figure 1). The principles of the fusiform ellipse, such as anatomy, skin tension, tissue movement, and suturing technique, are the same principles necessary to perform more advanced skin surgery, such as advancement flaps, curvilinear excisions, and M- or S-plasties.
This topic will discuss the design and execution of the fusiform/elliptical excision. Skin biopsy techniques, Mohs surgery, the principles of graft and flaps for reconstructive surgery, and head/neck anatomic danger zones are discussed separately.
●(See "Skin biopsy techniques".)
●(See "Mohs surgery".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Bichakjian CK, Halpern AC, Johnson TM, et al. Guidelines of care for the management of primary cutaneous melanoma. American Academy of Dermatology. J Am Acad Dermatol 2011; 65:1032.
- Book SE, Aasi SZ, Leffell DJ. Ellipse, ellipse variations, and dog-ear repairs. In: Surgery of the Skin: Procedural Dermatology, 2nd ed, Robinson JK, Hanke CW, Siegel DM, Fratila A (Eds), Mosby, St. Louis 2010. p.239.
- NCCN Guidelines Version 2.2014 - Basal Cell and Squamous Cell Skin Cancers http://www.nccn.org/professionals/physician_gls/pdf/nmsc.pdf (Accessed on July 07, 2014).
- NCCN Guidelines Version 4.2014 - Melanoma http://www.nccn.org/professionals/physician_gls/pdf/melanoma.pdf (Accessed on July 07, 2014).
- Nguyen TH, Quenby LE. Hemostasis. In: Surgery of the Skin: Procedural Dermatology, 2nd ed, Robinson JK, Hanke CW, Siegel DM, Fratila A (Eds), Mosby, St. Louis 2010. p.225.
- Alam M, Lee A, Ibrahimi OA, et al. A multistep approach to improving biopsy site identification in dermatology: physician, staff, and patient roles based on a Delphi consensus. JAMA Dermatol 2014; 150:550.
- Callahan S, Goldsberry A, Kim G, Yoo S. The management of antithrombotic medication in skin surgery. Dermatol Surg 2012; 38:1417.
- Löser C, Zeymer U, Nast A. [Platelet inhibitors and anticoagulants: managing blood thinners in dermatosurgery]. Hautarzt 2013; 64:553.
- Wright TI, Baddour LM, Berbari EF, et al. Antibiotic prophylaxis in dermatologic surgery: advisory statement 2008. J Am Acad Dermatol 2008; 59:464.
- Carmichael SW. The tangled web of Langer's lines. Clin Anat 2014; 27:162.
- Goldberg LH, Alam M. Elliptical excisions: variations and the eccentric parallelogram. Arch Dermatol 2004; 140:176.
- Zitelli JA. TIPS for a better ellipse. J Am Acad Dermatol 1990; 22:101.
- Smack DP, Harrington AC, Dunn C, et al. Infection and allergy incidence in ambulatory surgery patients using white petrolatum vs bacitracin ointment. A randomized controlled trial. JAMA 1996; 276:972.
- Campbell RM, Perlis CS, Fisher E, Gloster HM Jr. Gentamicin ointment versus petrolatum for management of auricular wounds. Dermatol Surg 2005; 31:664.
- Dixon AJ, Dixon MP, Dixon JB. Randomized clinical trial of the effect of applying ointment to surgical wounds before occlusive dressing. Br J Surg 2006; 93:937.
- Levender MM, Davis SA, Kwatra SG, et al. Use of topical antibiotics as prophylaxis in clean dermatologic procedures. J Am Acad Dermatol 2012; 66:445.
- RELATIVE CONTRAINDICATIONS
- PREOPERATIVE EVALUATION
- DESIGN OF THE FUSIFORM ELLIPSE
- EXECUTION OF THE FUSIFORM ELLIPSE
- Patient and surgical site preparation
- POSTOPERATIVE CARE
- POTENTIAL COMPLICATIONS
- Wound dehiscence
- EVOLUTION OF THE FUSIFORM ELLIPSE TO OTHER PROCEDURES
- SUMMARY AND RECOMMENDATIONS