Clinical Significance of the Modified Triple Advancement Flap for Closing Skin Defects / 대한피부과학회지

BACKGROUND: Triple advancement flap has been recently introduced to close the skin defect after Mohs microscopic surgery. OBJECTIVE: The aim of this study is to evaluate the clinical advantage of the modified triple advancement flap compared with rhomboid excision and closure. METHODS: The modified triple advancement flap was performed on nine patients with skin cancer. We observed the clinical course after surgery and compared the scar length and the amount of removed normal skin in triple advancement flap with those in rhomboid excision and primary closure, by using an image-analyzing program. RESULTS: The overall cosmetic and functional result was good. Partial flap necrosis was detected in one of nine patients, and hypertrophic scar developed in one of nine patients. The average scar length from the modified triple advancement flap was 102.1 mm, whereas it was 95.0 and 111.0 mm in 1:3 and 1:3.5 rhomboid excision with closure. The amount of removed skin was 716.3 mm2 in modified triple advancement flap, whereas it was 794.0 mm2 (1:3) and 1116.9 mm2 (1:3.5) in rhomboid excision with closure. CONCLUSION: The triple advancement flap might be used to close a defect in the area of trifurcation or bifurcation of skin tension lines, to spare the normal surrounding tissue as much as possible.

Effect of Modified Rhomboid Excision and Limberg Flap for the Treatment of Recurrent Pilonodal Sinus

PURPOSE: Recurrence of a pilonidal sinus after surgery is well known. Many surgical techniques have been developed but there is no efficient method available. This study evaluated the results of a Modified Rhomboid excision and Limberg flap of a pilonidal sinus, and examined the value of this method. METHODS: Five patients, who had been treated with a modified rhomboid excision and Limberg flap procedure for recurrent pilonidal sinus, were evaluated. The patient's age, gender, duration of symptoms, length of hospital stay, complications, time required for the return to normal activity, and prior history of surgery were evaluated. RESULTS: The mean age of the 5 patients (4 males and 1 female) was 22.7 years, and all had a history of previous surgery. The mean duration of symptoms was 4.2 years. Only one patient developed seroma. The mean hospital stay was 7.2 days, and the mean time to normal activity was 14.4 days. There was no recurrence. CONCLUSION: Modified Rhomboid excision and Limberg flap procedure is the optimal method for treating recurrent pilonidal sinus with low complication and recurrence rates.