The Paradigm of Surgical Ellipse Dimensions: Are the Length-to-Width Ratio of 3 to 4 and a Vertex Angle of 30º Correct?

Tamara R. Tilleman, M. M. Tilleman, M. H. A. Neumann

Dermatology Department, Mohs Micrographic Surgery Unit, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands.
Luxon, Inc., Brookline, USA.

DOI: 10.4236/ss.2013.44045                

Abstract

Background: It has been postulated that elliptical cutaneous excisions must possess a length-to-width ratio of 3 to 4 and a vertex angle of 30o or less in order to be closed primarily without creating a “dog ear”. These dimensions became axiomatic in cutaneous surgery and have been taught in the apprenticeship model for years. The present article examines the validity of that paradigm. Methods: We collected data from two sources: ellipses described in the literature (57 cases); and elliptical excisions performed at the authors’ outpatient clinic (83 cases). The surgical ellipse lengths, widths, and vertex angles were analyzed, and the data were compared to a mathematical formula used to generate a fusiform ellipse. Results: The length-to-width ratio of 3 - 4 was found to be inconsistent with the recommended vertex angle of 30o. In fact, a length-to-width ratio of 3 - 4 determines a vertex angle of 48o - 63o. A 30o vertex angle is only feasible with long length-to-width ration of about 7.5. Conclusions: The paradigm that surgical ellipses should have a vertex angle of 30o with length-to-width ratio of 3 - 4 is incorrect. Evidence from actual surgical practice and from mathematical formulation shows that either the length-to-width ratio must be larger than 3 - 4 or the vertex angle must be larger than 30 degrees.

Keywords

Elliptical Excision; Length-to-Width Ratio of 3 - 4; 30º Vertex Angle

Conflicts of Interest

The authors declare no conflicts of interest.

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