'Biaxial serial excision' or 'polyaxial serial excision'.

Sir,

I read with great interest the article ‘Biaxial serial excision: A technique to deal with benign skin lesions, and scars’ published in the Indian Journal of Plastic Surgery.[1] The method appears to be a great improvement over the standard ‘serial excision’ practiced by plastic surgeons as it helps to excise more skin tissue while limiting the length and extent of the scar itself.

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 1a 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.

Figure 1

(a-b) Line drawing showing excision of a scar in two axes

Figure 2

(a-b) Line diagram showing the excision of the same scar using multiple V's or W's occurs along multiple axes by forming multiple ellipses