Chapter 4.42: The Buried Dog-Ear Tip Stitch

Introduction

Application

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.

Suture Material Choice

Suture choice is dependent in large part on location. On the back and extremities, a 2-0, 3-0, or 4-0 absorbable suture material may be used, and on the face and other areas under minimal tension, a 4-0 or 5-0 absorbable suture is adequate.

Technique

1. The suture needle is inserted at 90 degrees into the underside of the dermis on the far side of the wound, 4-6 mm distant from the apex.

2. The first bite is executed by traversing the dermis following the curvature of the needle as with a buried dermal suture.

3. The needle is reloaded, and a horizontally oriented bite is taken through the base of the dog ear.

4. The needle is again reloaded, and the needle is inserted through the underside of the dermis, exiting at the dermal-epidermal junction on the opposite side of the wound from the first throw, in a mirror image of the first throw.

5. The suture material is then tied utilizing an instrument tie (Figures 4-42A, 4-42B, 4-42C, 4-42D, 4-42E, 4-42F, 4-42G).