Optimization of Incisions in Cutaneous Surgery including Mohs’ Micrographic Surgery

In chapter 1, a general introduction into the rationale of surgery and various techniques for cutaneous excisional biopsies and repairing the defects were described. In the studies described in chapter 2, the most economical patterns with regard to extra skin waste, scar length and vertex angle were investigated. A comparison of minimum waste area showed that the best patterns were the rhomboid and the mosque excision. The second comparison of the scar length showed that the length was almost independent of the pattern. The third comparison showed that the rhomboid and the S-shape patterns possessed the smallest vertex angles and thus minimized the formation of dog ear. Interestingly, the common surgical ellipse was observed not to have any advantage in any of the cut pattern categories. The currently held paradigm that the vertex angle of a surgical ellipse should be 30° or less for length-to-width ratios of lower than 4 was found to be mathematically incorrect. The circular excision pattern, i.e. a direct excision of a round lesion, was found superior to other patterns that were examined in that there was no skin waste and that the resulting scar length was the shortest. However, the circular excision had the highest vertex angle (180°), which resulted in large dog ear formation during closure.