‘Biaxial serial excision’ or ‘polyaxial serial excision’
However, I wish to differ on the terminology used for the technique ‘biaxial’, described by the author, as it gives an erroneous impression. Biaxial implies two axes as shown in Figure 1 a and b where, the skin laxity in two axes is taken advantage of, in order to close the skin edges. The author’s technique described as “edges of the ellipse (excision planned) are extended outwards into multiple W’S and V’s” can be analyzed as in Figure 2a and b where the multiple W’s or V’s can be joined to form multiple ellipses. One can now see that the axes of excision of these different ellipses are multiple and the technique takes advantage of skin laxity along multiple different axes. Therefore, geometrically speaking, the technique should be called‘Polyaxial serial excision› and not Biaxial serial excision’ as claimed by the author.
Biaxial serial excision: A technique to deal with benign skin lesions and scars
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.
Ambulatory serial excision of giant nevi.
Nevi over the size of a dime at the time of birth should probably be removed. Nevi this size often cannot be differentiated histologically from the true giant nevus that may cover over 50% of the body. Giant nevi have a 2%-30% malignant potential. In order to avoid the morbidity of split-thickness skin grafts when removing the larger nevi, we have been successful in serially excising many nevi as ambulatory procedures. Most moderately large nevi, regardless of their location, can be managed with this method.