Editing Skin excisions general (section)

== Circular excisions ==

* Often the easiest way, especially when there isn't a clear best way beforehand
* Excise the lesion then use skin hooks to determine the best orientation of closure
** Whichever way requires less tension and has less rounded apexes is generally better
** If there is too much tension on the wound, or surrounding anatomical structures are distorted, need to move on to flap or graft. Usually need to remove all sutures and start again with flap. The flap will be larger than you expect, even if the wound almost closes primarily.
* Watch out for pantographic expansion - the slight increase in length of the wound when you pull the circle closed. This can 'push' other structures out of the way. This can only be reduced by adding an elliptical incision at right angles and doing a kind of advancement flap.
* Excise the dog ears after placing the first few sutures in the middle