Zig-Zag Incision for Temporal Artery Biopsy: Technique and Rationale

Giant cell arteritis is a potentially devastating condition that relies on temporal artery biopsy (TAB) for definitive diagnosis. Although women are more likely to be affected by giant cell arteritis, they tend to endure shorter TAB lengths. This may be due to concerns for postsurgical scalp scarring. This paper describes a technique for TAB that utilizes a zig-zag incision to improve intraoperative exposure, increase biopsy length, and minimize risk of post-TAB scarring.

After marking Pitanguy line, a zig-zag incision is made posterior to the temporal hairline and dissection is performed to the superficial temporal fascia. The temporal artery is identified, ligated, and removed for biopsy. Careful attention is given to closure, with the deep and superficial layers closed separately. A retrospective analysis was completed on all TABs done with a zig-zag incision between September 2023 and February 2025. Demographic information, biopsy length, and complications were evaluated.

Thirteen biopsies of 11 patients were included in the analysis. The zig-zag incision for TAB facilitated excellent intraoperative exposure without increasing incision length. Mean (±standard deviation) TAB length was 4.8 ± 0.8 cm. No postoperative complications were reported, and excellent cosmetic results were achieved. The technique facilitated optimal TAB length while addressing concerns about scarring that might otherwise reduce diagnostic yield, especially in females.

The Zig-zag incision for TAB is safe and produces good cosmetic outcomes. Adoption of this technique may lead to increased TAB lengths and reduce the risk of a cosmetically unappealing post-surgical scar.