Скачать или смотреть How To Perform an Ellipse Excision - Vaseharan Suntharan

Ellipse excision is a surgical technique used to remove skin lesions, such as moles, cysts, or other small growths, while minimizing scarring and ensuring aesthetic results. This procedure is commonly employed by dermatologists, plastic surgeons, and general practitioners. The shape of the excision, resembling an elongated ellipse, allows for better wound closure, reducing the tension along the incision line and helping the wound heal more aesthetically.

Indications for Ellipse Excision
Ellipse excision is appropriate for:

Suspicious or malignant lesions, such as melanoma or basal cell carcinoma
Benign growths that are aesthetically unappealing or symptomatic
Removal of cysts or lipomas
Chronic non-healing skin ulcers or scars
Preoperative Considerations
Before performing an ellipse excision, consider the following steps:

Patient History and Physical Examination: Assess the lesion's history (onset, growth, or any associated symptoms like itching or bleeding). Perform a physical examination to evaluate the lesion's size, depth, and location.
Biopsy: If malignancy is suspected, consider a preoperative biopsy or plan for a wide-margin excision to remove any suspicious cells completely.
Informed Consent: Explain the procedure, possible complications (infection, bleeding, scarring), and alternative treatments.
Anesthesia: Local anesthesia (e.g., lidocaine with or without epinephrine) is typically sufficient for minor procedures. Larger lesions may require sedation or general anesthesia.
Step-by-Step Guide to Ellipse Excision
1. Marking the Lesion and Excision Lines
Ellipse Shape: Use a sterile surgical marker to outline the lesion and the excision lines, aiming for an elliptical shape. The long axis of the ellipse should be aligned with the skin tension lines (Langer’s lines) to improve healing and reduce scarring.
Margins: For benign lesions, mark a margin of 1–2 mm around the lesion. For malignant lesions, a wider margin (usually 5 mm or more) may be necessary to ensure complete removal.
2. Administering Local Anesthesia
Inject local anesthetic (e.g., lidocaine with epinephrine) around the marked area, ensuring complete coverage of the excision site.
Wait a few minutes to allow the anesthetic to take full effect.
3. Incision and Lesion Removal
Incision: Using a scalpel, make the first incision along the elliptical marks. Start at one end of the ellipse and follow the contour through to the opposite end.
Depth: The incision should extend into the subcutaneous fat to ensure complete removal of the lesion.
Undermining: Gently undermine the tissue below the incision (1-2 cm) to reduce skin tension and improve closure. Use scissors or a scalpel to release the tissue.
4. Hemostasis
Use cautery or pressure with sterile gauze to achieve hemostasis and minimize bleeding during the procedure.
5. Wound Closure
Sutures: Start by placing deep absorbable sutures (e.g., 3-0 or 4-0 Vicryl) in the subcutaneous tissue to minimize tension on the surface wound. These sutures help prevent wound dehiscence and enhance cosmetic results.
Close the skin with non-absorbable sutures (e.g., 4-0 or 5-0 nylon or Prolene), starting at the center of the wound and moving toward the ends. Interrupted or running sutures can be used based on the surgeon's preference and the location of the excision.
Tension Adjustment: Ensure that the tension is evenly distributed to avoid puckering at the ends of the ellipse.
6. Dressing the Wound
Apply an antiseptic ointment and cover the wound with a sterile dressing. For larger excisions, compression dressings may be applied to minimize swelling and promote proper healing.
Postoperative Care
Suture Removal: Typically, sutures are removed within 5 to 14 days, depending on the location. For facial lesions, sutures are often removed after 5–7 days, while those on the trunk or limbs may require longer.
Wound Care: Keep the wound clean and dry for the first 24–48 hours. After this period, the patient can clean the area gently with mild soap and water.
Scar Management: Silicone gel sheets, scar creams, or massaging the area may improve the final cosmetic appearance of the scar.
Complications
While ellipse excision is generally a safe procedure, potential complications include:

Infection: Redness, warmth, swelling, or pus at the wound site may indicate infection. Treatment typically includes antibiotics.
Bleeding: Hematoma formation or prolonged bleeding may occur if hemostasis is not adequately achieved during surgery.
Wound Dehiscence: If the wound does not heal properly or the tension is too high, the sutures may separate, requiring re-closure.
Scarring: Hypertrophic scars or keloids can develop in some patients, particularly in areas of high tension or in individuals prone to excessive scarring.