Modified S-plasty: an alternative to the elliptical excision to reduce the length of suture

When the tension obtainable with an elliptical excision of a skin lesion would be excessive, instead of resorting to skin grafts or flaps, it is possible to apply an alternative plastic that reduces the length of the suture by approximately one third and assumes a curved lazy-S profile, also improving aesthetic result.

This is obtained with a modified shortened S-plasty, which distributes the vectors of tension in two different directions at the apices and in the central part. The traction on the suture line is reduced, facilitating wound healing. Two different directions of the "S" can be chosen. In the case of oval or long lesions, if their major axis, natural direction of suture, does not fit to the anatomical site, it is possible, by applying the S plastic, to rotate the axis of suture by almost 90 degrees. One case is presented that illustrates the description. Differences between this technique and classic S-plasty are discussed.

The modified S-plasty reconstruction can represent a valid alternative to elliptical excision if the lesion to be removed is sufficiently large and when a shorter and curved suture line is preferable.