Scar orientation: Principles in plastic surgery

• Published in: Journal of cutaneous and aesthetic surgery Vol. 13; no. 2; pp. 152 - 153
• Main Authors: Amin, Kavit, Asher, Christian, Hamilton, AAlexander, Mowatt, David
• Format: Journal Article
• Language: English
• Published: Mumbai Wolters Kluwer India Pvt. Ltd 01.04.2020; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: Biopsy; Edema; healing; Melanoma; Plastic surgery; Practice Points; Primary care; scar; scar orientation; Skin; Skin cancer; skin cancer; Healing; scar orientation; scar
• ISSN: 0974-2077; 0974-5157
• DOI: 10.4103/JCAS.JCAS_5_20

For biopsy proven skin cancers that are deemed to be high risk, a wide local excision (WLE) is recommended to reduce the risk of local recurrence. For this reason, it is pragmatic to account for the likelihood of a WLE at the time of the initial biopsy. We illustrate a staged approach to excision of lesions to facilitate this, bearing in mind the optimal reconstruction is primary closure. In our experience as plastic surgeons, having to perform a locoregional flap or skin graft prevents the opportunity to perform a local anesthetic procedure. This increases the risk of postoperative complications, especially if adjuvant radiotherapy further exposes reconstructed tissues to radiation toxicity. Collectively, this often results in an inferior aesthetic outcome. We value the referrals from allied colleagues and want to share the principles we adhere to when planning an excision biopsy, which aid in the delivery of the optimal reconstruction.