The reconstructive ladder is a well-established concept in Plastic Surgery proposed to achieve wound closure using a stepladder approach from simple to complex procedures and it continues to evolve from when it was presented for the first time. We describe a new surgical technique that allows skin excision and primary wound closure avoiding donor site morbidity from skin grafts and avoiding large scars from loco-regional flaps: the parallelogram excision technique.
Fifteen patients with skin lesions underwent this procedure. Six months' follow-up results showed a) good scar healing, b) total excision of lesions, and c) patient acceptance and satisfaction from the usage of this technique. We conducted a geometrical analysis of the parallelogram’s design to study the optimal geometrical condition to achieve all these three factors. We propose that the parallelogram excision of skin lesions proves to be a unique new wound closure technique that may add a new rung to the reconstructive ladder.