The Surgical Dog Ear | Why Isn’t My Scar Flat After Skin Surgery?
A dogear is a redundancy in the skin that can occur when the skin is stitched together. It has also been called a standing cone, pucker or pleat in the skin and can arise when wounds are repaired after Mohs surgery, excisions or other skin surgeries.
“Despite proper healing, having no complications in the post-op period, a dog ear can significantly effect the cosmetic outcome of a surgery,” says Dr. Adam Mamelak, dermatologist and fellowship-trained Mohs surgery in Austin, Texas.
So Many Stitches!
The linear closure is probably the most common repair used in skin surgery, known for its robust healing and superior cosmetic outcomes. “Simply put, the wound edges are pulled together and sutured in a straight line,” explains Dr. Mamelak.
Patients are often surprised by the number of stitches they need to repair the skin after their skin cancers have been removed. “For a small area, maybe 1/4 inch in diameter, they don’t anticipate a long incision line.” The reason, Dr. Mamelak explains, is often related to the dogear.
When tumors are removed from the skin, they typically leave a round or oval wound that needs to be repaired. “If you pull a circle together side-to-side, you get puckers or pleats on the skin,” says Dr. Mamelak.
“In order to get the skin to lie flat, the circle can be elongated into an ellipse. This football or eyeball shape comes together as a straight line on the skin, without any puckers.”
There are a number of ways to reconstruct the skin after Mohs surgery. Depending on where the skin cancer grows and its proximity to the eyes, nose or another structure on the body, your surgeon will select a skin graft, flap, or linear closure to repair the skin. Unfortunately, dog ears can occur with just about all of these surgical repairs. Proper planning and technique is the best way to reduce the chance of a dog ear from occurring and obtain the best cosmetic result.
Dr. Mamelak treats skin cancer patients with Mohs surgery and performs other skin surgery procedures at Sanova Dermatology and the Austin Mohs Surgery Center. If you’ve had an unanticipated outcome after your surgery, please contact us today.