The Art of Excision
Why Linear Incision & Blunt Dissection Outperform Elliptical Excision
Minor surgery is as much an art as it is a science. Every incision, every dissection, and every closure leaves an imprint—not just on the skin but on the patient’s experience and outcome. One of the most common debates in minor surgical excisions is linear incision with blunt dissection versus traditional elliptical excision for cysts and lipomas.
If you still default to elliptical excision, it’s time to rethink your approach. Here’s why the linear technique is not only more efficient but also superior in terms of cosmetic and functional outcomes.
The Problem with Elliptical Excisions
For years, elliptical excision has been the standard method for removing cysts and lipomas. It seems straightforward: make an ellipse around the lesion, dissect down, remove the mass, and close the defect with sutures. However, this method has several key drawbacks:
- Unnecessary Skin Loss – The elliptical shape requires excising extra healthy skin, leading to larger wounds and wider scars.
- Increased Tension on Closure – Removing more tissue means greater tension when closing, increasing the risk of hypertrophic scarring.
- Longer Procedure & More Sutures – More cutting, more dissection, more suturing—more time.
- Higher Risk of Seroma & Haematoma – Larger wounds create more dead space, increasing the likelihood of post-operative fluid accumulation.
Linear Incision & Blunt Dissection: A Better Approach
A linear incision directly over the lesion, combined with blunt dissection, allows for a cleaner, quicker, and more aesthetically pleasing excision. Here’s why it works better:
1. Precision Without Excess Tissue Loss
A simple linear incision, just slightly longer than the lesion itself, avoids the unnecessary removal of healthy skin. This results in a smaller scar and faster healing.
2. Blunt Dissection Preserves Natural Planes
Instead of sharply cutting around the lesion, use blunt dissection with scissors or your fingers to separate tissue planes naturally. This reduces trauma to surrounding structures and minimises post-operative pain.
3. Less Dead Space, Lower Risk of Complications
Since you’re not removing excess skin, the closure is more anatomical, reducing the risk of seroma or haematoma formation. A well-placed deep suture is usually sufficient to close any minor dead space.
4. Better Cosmetic Outcomes
A straight-line scar follows natural skin tension lines, making it less noticeable than a long elliptical scar. Patients appreciate a smaller, finer scar—especially in cosmetically sensitive areas.
5. Faster Procedure, More Efficient Practice
Less cutting, less suturing, and less time per procedure. In a high-volume minor surgery setting, this technique improves efficiency without compromising patient safety.
How to Perform a Linear Incision & Blunt Dissection Excision
- Mark the lesion – A simple line over the lesion is sufficient.
- Infiltrate local anaesthetic – Ensure good field anaesthesia while minimising tissue distortion.
- Make a linear incision – Extend slightly beyond the lesion’s borders.
- Use blunt dissection – Separate the lesion from surrounding tissue using scissors or your finger.
- Deliver the lesion intact – Avoid rupture, particularly for cysts, to minimise the risk of recurrence.
- Achieve haemostasis – Small bleeders can be controlled with pressure, cautery, or ligation.
- Close in layers – A deep absorbable stitch if required, followed by a simple interrupted or subcuticular closure for optimal cosmetic results.
Final Thoughts: Less is More
As doctors, we continually refine our skills to provide better outcomes with less trauma. The shift from elliptical excision to linear incision with blunt dissection embodies this principle. It is quicker, cleaner, and cosmetically superior—and once you master it, you’ll wonder why you ever did it differently.
Do you use this technique? Have any tips or experiences to share? Put them in the comments!
Author - Prof Abbas Tejani, Honorary Associate Professor of Primary Care.