Parallelogram Excision: An Algorithmic Approach for Excision Designs in High-Tension Skin Areas

Area of Science:

• Dermatologic Surgery
• Surgical Oncology
• Plastic Surgery

Background:

• Traditional elliptical excisions for skin lesions not aligned with tension lines often require excessive tissue removal.
• This can lead to broader scars and suboptimal cosmetic results.
• A new technique is needed to optimize excision and closure for such lesions.

Purpose of the Study:

• To introduce and evaluate the parallelogram excision technique for skin lesions.
• To compare its efficacy against traditional elliptical excisions.
• To assess its impact on excised tissue volume and scar quality.

Main Methods:

• Geometrical analysis comparing elliptical and parallelogram excisions.
• Clinical pilot study of the parallelogram technique on 16 patients with skin lesions (≤4 cm, 45°-60° orientation to tension lines).
• Assessment of scar quality using the Patient and Observer Scar Assessment Scale (POSAS) at 6 months.

Main Results:

• Geometrical analysis confirmed reduced healthy tissue excision with the parallelogram technique.
• The clinical study included 16 patients (mean age 63.5) with various skin lesions.
• Six-month follow-up showed uneventful healing, good scar quality (observer POSAS: 16, patient POSAS: 19), and complete lesion excision.

Conclusions:

• The parallelogram excision technique is a viable option for skin lesions not parallel to tension lines.
• It offers a reproducible, surgeon-friendly method with favorable use of local tension for good scar quality.
• This technique excises less healthy tissue compared to traditional elliptical methods.