Direct closure of round skin defects: a four-step technique with multiple subcutaneous and cutaneous "figure-of-8" sutures alleviating dog-ears

Excisional biopsies of rounded lesions are performed daily by surgeons. The objective of this article is to establish a surgical technique for direct closure of circular and elliptical defects without the need for additional excision of dog-ears. A four-step technique based on multiple cutaneous and subcutaneous "figure-of-8" sutures is presented. When correctly placed, these sutures can equally distribute the excess tissue along the scar and alleviate dog-ears. The results of the 65 presented cases show that this technique yields short scars and saves healthy skin. A significant reduction of the length-to-width ratio and the arc-to-scar length ratio is obtained. Direct closure of a circular or elliptical defect without stipulating a 3:1 length-to-width ratio is feasible. Among the advantages of the technique are that no excessive healthy tissue is removed and that the scar length is reduced. The long-term outcome is a scar that is thin, linear, flat, and concealed in the body structure.