Excision of the thrombosed external hemorrhoid. A Excision of the thrombosed external hemorrhoid. A. The dotted line represents the incision lines to remove the skin and underlying thrombosis. B. Injection of local anesthetic solution. C. The skin incision has already been performed. The skin and underlying thrombosis are dissected free with a scissors. D. The ellipse of skin and the underlying thrombosis have been removed. The fibers of the underlying external anal sphincter muscle are visible. Source: Chapter 68. External Hemorrhoid Management, Emergency Medicine Procedures, 2e Citation: Reichman EF. Emergency Medicine Procedures, 2e; 2013 Available at: http://accessemergencymedicine.mhmedical.com/DownloadImage.aspx?image=/data/books/reic2/reic2_c068f004.png&sec=45348904&BookID=683&ChapterSecID=45343708&imagename= Accessed: October 10, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved