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

Koong, Sun Nam; Kim, Ji Seok; Kim, Jee Young; Gye, Ji Won; Hong, Seung Phil; Kim, Myung Hwa; Park, Byung Cheol

Abstract

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.