ABSTRACT
The incisions are the most characteristic feature of Muller’s technique. There are
techniques described as “stab avulsion” that use common hemostatic forceps,
which cannot be introduced and maneuvered through an incision ,4-5 mm long. Muller himself calls a 2 mm incision “large” and a 3 mm one “enormous.”
This “obsession” with the size of the incisions is based on the observation of the
scars: the difference between a practically invisible scar and an unsightly scar
could be no more than 1 mm. This is true for normal skin, and even more for
skin that tends to form reddish, brown, hypertrophic or keloid scars: the
smaller the incision, the smaller the risk of adverse sequelae. Therefore, one
should make the smallest possible incisions, even if vein avulsion becomes
more time consuming. During the operation many of the smaller stab incisions
may enlarge. This enlargement is primarily due to stretching of cutaneous
elastic fibers. Fortunately, at the end of surgery, with compression, incisions
retract to their original size.
