SURGICAL TECHNIQUES
DOUBLE ROTATION SKIN CLOSURE: AN ALTERNATIVE TO ELLlPTlClAL CLOSURE
THOMASH. ROBBINS Melbourne
A slmple method of closure 01 circular skin defects is presented. Even lor small defects it is often appropriate on occasions when elliptical excision is either not possible or inferior.
METHOD THis is well shown in Figures 1 and 2, the skin adjacent to the circular defect, instead of being excised as part of an ellipse, is raised as two opposite based skin flaps. Each flap is rotated into the circular defect so that they meet along its diameter. The resultant scar is roughly Z-shaped. DISCUSSION Distortion of important adjacent aesthetic landmarks (e.g., eyebrow, vermilion) can be avoided. Wound tension is reduced and redirected along the length of the scar rather than across it. The method has been used to advantage as an alternative to elliptical excision in most areas, for example, the temporal region, forehead, upper and lower lips, nose, vermilion of lip, mental region, trunk and limbs. Distortion of surrounding aesthetic
boundaries, flattening of contours and undue tension on closure often preclude the use of elliptical excision and closure. Small defects in the palm have been closed by this method where skin grafting has been the only alternative. The only disadvantage of the method is the multidirectional scar. In many areas, particularly those mentioned above, this is not as great as disadvantage as might bethought. Only wherethere is an abundance of loose adjacent skin and the lines of election are definite (for example, the cheek area i n the elderly) does elliptical excision and closure have definite advantages. CONCLUSION Double rotation skin closure as described should be considered as an alternative whenever elliptical excision and closure is contemplated.
Reprints: I9 Royal Avenue, Sandringham, Victoria 3191
650
AUST N.Z. J. SURG,VOL 48 - No 6, DECEMBER. 1978
DOUBLE ROTATION SKIN CLOSURE
ROBBINS
FIGURE 1 Case 1; (A) postauricular basal cell carcinoma Proposed excision and double rotation flaps are marked
(6) the excistonal defect
( c ) adjacent small double rotation flaps have been raised
(D)both flaps have been rotated to close the excisional defect Direct elliptical closure in this site is hindered by the fibrous adhesions of the skin to the underlying deep fascia
AUST. N.Z. J. SURG..VOL. 48 - No 6,DECEMBER, 1978
651
ROBBINS
DOUBLE ROTATION SKIN CLOSURE
FIGURE 2: Case 2; (A) large basal cell carcinoma of right temporal region. The excisional margin and the proposed adjacent flap have been marked; (6) the lesion has been excised and the adjacent flaps raised; (C) the flaps have been rotated in to close the excisional defect: (D)final result six months later. The adjacent aesthetic boundaries of the eyebrow and temporal hairline have not been distorted. Distortion of these by direct elliptical closure would have been unacceptable. A skin graft would have produced an inferior aesthetic result.
652
AUST
N.Z.J. SURG..VOL. 48 - No.6, DECEMBER. 1978
DOUBLE ROTATION SKIN CLOSURE: AN ALTERNATIVE TO ELLlPTlClAL CLOSURE
THOMASH. ROBBINS Melbourne
A slmple method of closure 01 circular skin defects is presented. Even lor small defects it is often appropriate on occasions when elliptical excision is either not possible or inferior.
METHOD THis is well shown in Figures 1 and 2, the skin adjacent to the circular defect, instead of being excised as part of an ellipse, is raised as two opposite based skin flaps. Each flap is rotated into the circular defect so that they meet along its diameter. The resultant scar is roughly Z-shaped. DISCUSSION Distortion of important adjacent aesthetic landmarks (e.g., eyebrow, vermilion) can be avoided. Wound tension is reduced and redirected along the length of the scar rather than across it. The method has been used to advantage as an alternative to elliptical excision in most areas, for example, the temporal region, forehead, upper and lower lips, nose, vermilion of lip, mental region, trunk and limbs. Distortion of surrounding aesthetic
boundaries, flattening of contours and undue tension on closure often preclude the use of elliptical excision and closure. Small defects in the palm have been closed by this method where skin grafting has been the only alternative. The only disadvantage of the method is the multidirectional scar. In many areas, particularly those mentioned above, this is not as great as disadvantage as might bethought. Only wherethere is an abundance of loose adjacent skin and the lines of election are definite (for example, the cheek area i n the elderly) does elliptical excision and closure have definite advantages. CONCLUSION Double rotation skin closure as described should be considered as an alternative whenever elliptical excision and closure is contemplated.
Reprints: I9 Royal Avenue, Sandringham, Victoria 3191
650
AUST N.Z. J. SURG,VOL 48 - No 6, DECEMBER. 1978
DOUBLE ROTATION SKIN CLOSURE
ROBBINS
FIGURE 1 Case 1; (A) postauricular basal cell carcinoma Proposed excision and double rotation flaps are marked
(6) the excistonal defect
( c ) adjacent small double rotation flaps have been raised
(D)both flaps have been rotated to close the excisional defect Direct elliptical closure in this site is hindered by the fibrous adhesions of the skin to the underlying deep fascia
AUST. N.Z. J. SURG..VOL. 48 - No 6,DECEMBER, 1978
651
ROBBINS
DOUBLE ROTATION SKIN CLOSURE
FIGURE 2: Case 2; (A) large basal cell carcinoma of right temporal region. The excisional margin and the proposed adjacent flap have been marked; (6) the lesion has been excised and the adjacent flaps raised; (C) the flaps have been rotated in to close the excisional defect: (D)final result six months later. The adjacent aesthetic boundaries of the eyebrow and temporal hairline have not been distorted. Distortion of these by direct elliptical closure would have been unacceptable. A skin graft would have produced an inferior aesthetic result.
652
AUST
N.Z.J. SURG..VOL. 48 - No.6, DECEMBER. 1978
