Ann Dermatol.  2009 Feb;21(1):102-105. 10.5021/ad.2009.21.1.102.

Two Cases of Annular Skin Defects Repaired with Quadruple Fan Flaps (O-X Flap)

• Oh JE
• Lee SM
• Whang KK

• KMID: 2172081
• DOI: http://doi.org/10.5021/ad.2009.21.1.102

Abstract

Nowadays, patients have high expectations when it comes to minimization of postoperative scarring after dermatologic surgical procedures. When an annular lesion is being excised, normal skin should be excised, as well, to prevent a dog ears resulting in a long scar. We introduce a new flap reducing the scar length in annular defects. In order to avoid a long scar, we designed a quadruple fan flap (O-X flap) that is a variation of the rotation flap. It consists of four rotation flaps arranged like fans, with open and closed configuration. We suggest that the quadruple fan flap (O-X flap) is a viable option for treating annular skin defects, because it shortens the scar line, preserves normal tissue, and provides a cosmetically favorable outcome.

Keyword

Annular skin defect; O-X flap; Quadruple fan flap

MeSH Terms

Animals
Cicatrix
Dermatologic Surgical Procedures
Dogs
Ear
Humans
Skin

Figure

• 

  Fig. 1 (A) Draw imaginary vertical and horizontal axes at 90 degrees to each other, considering the relaxed skin tension line and adjacent structures. Make point 'a'' at radius distance from point 'a'. (B) Draw a tangent line from point 'a'' to the circle. Repeat this procedure for each point (b'~d'). The resulting structure looks like a vane. (C) Excise four straight lines and four tangent lines including the margin of the lesion along the bold line. Rotate each flap into the center of the circle, with a cruciform configuration (red and green). Suture the points of two rotated flaps together at the center. In order to prevent tip necrosis, place the suture tips of the two rotated flaps slightly away from each other (red and green are placed slightly away). Rotate the others as above (blue and yellow). (D) Close the sides together, creating an X-shaped closure line.

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  Fig. 2 (A) Congenital melanocytic nevus on a 24-year-old woman's forearm. (B) Design of the quadruple fan flap. (C) Immediate postoperative photo. We applied a lazy S-plasty design. (D) Forty-day postoperative photo. The scar length in the quadruple fan flap was much shorter than that seen in elliptical excisions.

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  Fig. 3 (A) Neurofibromas on a 27-year-old woman's arm. (B) Design of the quadruple fan flap. (C) Eight-day postoperative photo. In order to prevent tip necrosis, we placed the tips of two rotated flaps slightly away from each other. The scar length for the quadruple fan flap was approximately the same as that seen with elliptical excisions.

Reference

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