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Presentation

Three Pearls for Managing Dog Ears in Cutaneous Surgery

Description

The transcript explains dog ears as a common cosmetic and sometimes painful complication in cutaneous surgery, influenced by tissue dynamics, surface contour, surgical technique, and wound geometry. While the classic way to prevent them is a symmetric fusiform excision with a narrow apical angle and a length-to-width ratio of about 3 to 4 to 1, this creates a longer scar. The speaker offers three practical alternatives to reduce scar length without sacrificing cosmetic results: first, close a circular defect after excision and undermining, then remove the dog ears after closure by lifting and trimming only the excess tissue; second, use the “three-bite” technique to anchor the dog ear to the deep plane and flatten it without excessive tissue removal; and third, sometimes leave small dog ears alone, since those in certain locations such as the hands, peritibial area, and trunk, especially if under 4 mm, may resolve on their own over time. The overall message is to manage each case flexibly, choosing the least invasive effective option.

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Conclusions

Dog-ears are common in cutaneous surgery, and their management should be tailored to tissue dynamics, surface contour, technique, and wound geometry rather than relying on one fixed excision shape.
A circular excision followed by closure can be preferable to pre-planning a fusiform excision because it allows the final tension lines to declare themselves and often produces a shorter, better-oriented scar.
When dog-ears remain after closure, excising only the excess tissue can remove them effectively while minimizing unnecessary loss of healthy skin.
The three-bite technique can flatten a dog-ear by anchoring it to the deep plane, reducing the need for larger tissue removal and limiting scar length.
Small dog-ears in selected locations, especially on the hand, pretibial area, or trunk, may resolve on their own and can be safely observed.
Overall, flexible intraoperative decision-making can preserve cosmetic outcomes while reducing scar length, operative time, and patient discomfort.