Brief Summary

When the opposing sides of a wound are uneven, simple closure can distort the adjacent skin, resulting in the formation of a “dog ear”. This deformity can occur when the original wound is irregular, or can be produced when sutures are misplaced during the repair of an otherwise regular wound. Placing the sutures in the midpoint of each side of the wound and bisecting the wound sequentially can help avoid this deformity in the case of regular wounds. The technique described below is helpful for the repair of natively irregular wounds or irregular edges that arise during the repair of natively regular wounds.

Technique

1. Incise the skin at the apex of the wound, approximately 45 degrees relative to the line of the wound, in the direction of the dog ear. This will free the excess tissue.
2. Pull the new excess tissue and align this with the newly created wound and you can determine the margins of excess tissue to be excised, typically a triangular shape.
3. The newly created wound edges lie flat and can be sutured closed in the usual fashion.