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M-plasty is a refined surgical technique used to excise skin lesions or close cutaneous defects with minimal tension and optimal cosmetic results; this technique is especially beneficial in anatomically complex areas, such as near joints, curved surfaces, or regions where straight-line closures may result in dog ears, puckering, or excessive tension. The M-plasty involves modifying the traditional elliptical excision by adding 2 small triangular extensions—typically 30 to 60 degrees—at each end of the incision. This design facilitates better alignment with relaxed skin tension lines, reduces scar length, and distributes tension more evenly across the wound. By minimizing tissue distortion and preserving functional mobility, M-plasty supports both aesthetic and reconstructive goals. This educational activity provides clinicians with a detailed understanding of the indications, design, and execution of M-plasty, improving competence in surgical planning and wound closure. Participants learn to select appropriate cases, design flaps precisely, and manage postoperative care to reduce complications and improve scar outcomes. The course emphasizes the value of interprofessional collaboration—engaging dermatologists, plastic surgeons, surgical nurses, and wound care specialists—to support comprehensive surgical care. Effective teamwork enhances surgical precision, patient safety, and satisfaction, ultimately leading to superior functional and cosmetic results in M-plasty procedures. Objectives: Identify anatomical regions and clinical scenarios where M-plasty provides optimal wound closure and tension reduction. Screen patients and lesions to determine when M-plasty is an appropriate surgical option. Assess wound orientation, closure tension, and surrounding skin laxity to plan the M-plasty design. Collaborate with interprofessional healthcare teams to ensure precise preoperative planning and postoperative wound care. Access free multiple choice questions on this topic.

An M-plasty is an excisional technique used to remove standing cutaneous deformities, also known as dog ears, from the end of a linear wound repair. Dog ears arise from the redundant gathering of tissue when overly obtuse angles (>30 degrees) are used at the ends of surgical excisions. Many different techniques address dog ears. The primary nonexcisional technique involves distributing the excess skin on 1 side of the incision evenly relative to the other side by placing sutures at wider intervals on the longer side of the incision compared to the shorter side, thereby balancing tension across the wound. This approach may not work in all situations and is dependent upon the degree of tissue redundancy and overall wound length. For example, this technique will have a limited impact on short incisions or large dog ears. The most commonly employed surgical option to remove a dog ear is direct excision of the excess tissue. A triangular piece of tissue, known as a Burow triangle, can be removed anywhere along the length of the incision. Typically, a Burow triangle is taken at the end of the incision, increasing the scar's final length.[1] An M-plasty is an alternative to this technique and offers the additional benefit of reducing the final scar length while conserving adjacent normal tissue.[2] In some cases, an M-plasty may be employed at the end of an incision to avoid extending the scar across an aesthetic subunit boundary or disrupting an otherwise intact anatomical structure, albeit at the cost of introducing a bifurcated (forked) configuration to the wound termination. This trade-off may, in certain cases, negatively affect the cosmetic acceptability of the final result.[3][4]

Complications associated with M-plasty are similar to those observed with other primary wound closure techniques. In addition to pain, bleeding, infection, and the potential need for revision surgery, there remains the possibility of cosmetically suboptimal scarring. Patients may find that the bifurcated nature of the final scar is noticeable, or the scar itself may ultimately become widened, hypertrophic, atrophic, hyperpigmented, hypopigmented, or erythematous. Poor scar design, suboptimal execution, or delayed wound healing can lead to persistent standing cutaneous deformities. Management strategies for unsightly scarring may include: Topical therapies, such as silicone gel sheeting or depigmenting agents like hydroquinone Laser resurfacing, using ablative or nonablative fractional devices, particularly for texture and color irregularities Intense pulsed light (IPL) treatment for persistent erythema Microneedling, chemical peels, or intralesional corticosteroids in selected cases Surgical scar revision for refractory or anatomically distorted scars Photoprotection remains essential throughout remodeling to prevent dyspigmentation, particularly in individuals with Fitzpatrick skin types IV–VI.[21][22]

Effective execution of M-plasty requires not only surgical skill but also coordinated interprofessional collaboration to optimize patient outcomes, safety, and satisfaction. Surgeons and advanced practitioners must be proficient in selecting appropriate candidates for M-plasty, recognizing ideal anatomic locations, and tailoring the design to minimize tension and preserve functional and cosmetic outcomes. Nurses are vital in pre and postoperative education, wound care, and monitoring for complications such as infection or dehiscence. Communication between all care team members ensures proper timing of dressing changes, suture removal, and pain control, all of which are crucial for optimal healing and patient-centered recovery. Incorporating pharmacists into the care team enhances patient safety through proper medication reconciliation, allergy screening, and postoperative analgesia planning. Wound care specialists may assist with dressing selection and long-term scar management, while physical or occupational therapists may be involved when incisions are near joints or functionally sensitive areas. Interprofessional communication and shared decision-making ensure alignment in treatment goals and patient preferences, ultimately improving satisfaction and reducing complications. Coordinated follow-up and documentation help maintain continuity of care, making M-plasty a successful and safe reconstructive technique when delivered through a collaborative healthcare model.

Depending on the location of the wound, nurses may be responsible for suture removal approximately 7 to 14 days postoperatively. When procedures are performed in cosmetically sensitive areas, such as the face, nursing staff should also educate patients on the importance of protecting the healing wound from ultraviolet exposure, which can contribute to dyspigmentation and hypertrophic scarring. Patients should be advised to keep the wound covered or apply a broad-spectrum sunscreen with a minimum sun protection factor of 30 outdoors. Photoprotection should be maintained consistently until the scar matures, typically over 12 months.

Postoperative nursing and allied healthcare team monitoring should include regular assessment of wound healing, signs of infection, and early identification of complications such as dehiscence or hypertrophic scarring. Patient adherence to wound care protocols and photoprotection should also be reinforced during follow-up visits to optimize functional and cosmetic outcomes.