Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Sep;45(3):522-5.
doi: 10.4103/0970-0358.105965.

Biaxial serial excision: A technique to deal with benign skin lesions and scars

Kalpesh J Gajiwala  1
Affiliations

Biaxial serial excision: A technique to deal with benign skin lesions and scars

Kalpesh J Gajiwala. Indian J Plast Surg. 2012 Sep.

Abstract

Background: In the best of hands, the ultimate surgical scar of an otherwise well-performed surgery is unpredictable, and surgical techniques are constantly evolving to prevent or revise large scars. The present series uses the principles of serial excision to reduce the eventual scar length.

Materials and methods: Between January 1991 and December 2010, 30 patients were operated upon. In the first stage, a lesion was reduced in two dimensions with the intent to create a smaller lesion with the long axis favourably placed. The residual lesion was then excised after 4 weeks or more.

Results: The resultant scars were smaller and better aligned, with an excellent skin match.

Conclusion: A well-planned serial excision in a biaxial manner helps reduce the final scar.

Keywords: Biaxial serial excision; scar length; scar orientation.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
(a) A trapezoid tattoo on the forehead with possible designs of Limberg's flap. The inner marking is for the first stage of serial excision. (b) Residual lesion following excision, stage 1. (c) Stage 2, post excision final scar
Figure 2
Figure 2
(a) An oval scar over the right cheek. (b) The outer marking of the scar and the inner markings for a biaxial excision, to reduce the size of the lesion in two dimensions. (c) The residual lesion at the end of the 1st stage. (d) Following the second stage excision. (e) The final result. The scar is well aligned with RSTL and there is no distortion of the lower eyelid
Figure 3
Figure 3
(a) A large nevus on the chin, this was the first case done on 31 January 1991. (b) Serial excision 1st stage, the central lesion is excised and the edge within the residual lesion is further excised with multiple ‘v’s, which can be gathered to reduce the size of the lesion. (c) After the triangular defects are closed with purse string closure, the size of the residual defect is the same as the central lesion removed. (d) The length of the scar following second stage, almost the same as the original lesion. An Elliptical incision primarily would have extended the scar almost to the lip
Figure 4
Figure 4
(a) Mole on the philtrum. Elliptical incision would have crossed the white roll and deformed the shape of the philtrum and the cupid's bow. (b) The residual defect following a biaxial serial excision and the change of direction of the scar. c) The final result. No distortion of the philtrum, cupid's bow, white roll
Figure 5
Figure 5
(a) Nevus left temporal area. Elliptical single stage excision would leave a long scar, with a pull on the lateral eyebrow. (b) Biaxial serial excision, the residual lesion. (c) The final result
Figure 6
Figure 6
(a) Another lesion over the chin, with the marking of an ellipse for primary excision and reconstruction. Note the possible length. (b) Following a biaxial excision, within the lesion. (c) After a purse string closure, the residual lesion. (d) The final scar length is almost the same size as the long axis of the lesion
See this image and copyright information in PMC

References

    1. Feins NR, Rubin R, Borger JA. Ambulatory serial excision of giant nevi. J Pediatr Surg. 1982;17:851–3. - PubMed
    1. Sparkuhl K. Switzerland: International Hair Transplant Symposium, Lucerne; 1978. Scalp reduction: Serial excision of the scalp with flap advancement.
    1. Bosley L, Hope C, Montroy RE, Staub PM. Reduction of male pattern baldness in multiple stages: A retrospective study. J Dermatol Surg Oncol. 1980;6:498–508. - PubMed
    1. Converse JM. La réduction graduelle des difformités tégumentaires: H. Morestin, M.D., Paris (Bull. et mém. Soc. chir. Paris, 41: 1233, 1915. Plast Reconst Surg. 1968;42:163–72. - PubMed
    1. Davis JS. Philadelphia: P. Blakiston's Son and Co; 1919. Plastic Surgery: Its principles and practice; p. 26.