Editing Face excisions


Penington's favoured excision lines, with major areas of contention in red


== General advice: ==

* Never pull down the lower eyelid, which will lead to ectropion
* Glabella - vertical scars


== Forehead: ==

* Small lesions, or those on mid to upper forehead, should come off with a horizontal excision
* Just be aware of the danger of pulling the eyebrow upwards. Some excisions lower down or with bigger lesions should have a vertical ellipse.
* Be careful of temporal branch of facial nerve in the temporal region, which is quite superficial.
**

== Nose ==

* Skin becomes more loose superiorly, and can be transferred for local flap closures

== Ear ==

* General considerations
** Avoid sharp angles in cartilage - tend to become more prominent over time
** A smooth continuous helical rim is the most important feature to aim for
* Superior margin of helix:
** Ring block to ear
** Excise wedge of lesion, including cartilage (to avoid positive deep margin). Can use scissors to go through cartilage and posterior ear skin. A true wedge resection goes deep into the ear, to allow the helix to come back together without being distorted. According to Farquharson's, need to take a slightly wider rim of cartilage than skin to allow easy re-approximation.
** Direct pressure or diathermy to bleeding
** Adjacent through-and-through silk sutures, kept long and clipped, to allow manipulation of ear
** Interrupted 4/0 Monocryl/Vicryl Rapide to anterior skin
** Flip ear and consider putting a few sutures in the cartilage - not essential according to Murtagh, Farquharson also says unnecessary.
** Trim back cartilage so it can be fully covered by skin
** Suture posterior ear skin with more interrupted
** Chlorsig ointment BD
** Sutures out in a week if non-absorbable
*

[[Category:Skin, soft tissue and wounds]]