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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. On the back and extremities, a 2-0, 3-0, or 4-0 nonabsorbable suture material may be used, and on the face and other areas under minimal tension, a 4-0 or 5-0 nonabsorbable suture is adequate. Alternatively, fast-absorbing sutures may be used as well.
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The needle is inserted near the base of the dog ear in line with the long axis of the defect.
The needle courses deep to the dog ear, exiting where the incision line meets the dog ear.
The needle is then reinserted moving in the same direction 3-6 mm further along the wound edge.
The needle exits by passing through the epidermis just lateral to the incision line.
The suture is then tied with an instrument tie, securing the dog ear snug to the surrounding skin (Figures 5-41A, 5-41B, 5-41C, 5-41D).
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This technique works best for small standing cones in lax skin, where all that is needed is for the suture to temporarily tamp down the dog ear. In some locations, such as convexities over the forehead, even defects repaired with a 4:1 ellipse may still display residual standing cones at the apices; therefore, this approach may be used as an adjunct in such cases ...