We used the quadruple fan flap to reduce scar length and achieve results superior to those seen with elliptical excisions. Our method consists of four fan-like rotation flaps arranged in open and closed configuration3
. This design results in a scar that is the same size as the lesion.
Elliptical excision has been the most commonly used surgical method for treating annular defects. But, if a lesion is excised in an elliptical fashion, the long axis needs to be three or four times the diameter of the lesion. If the ellipse is too short, or one side of the ellipse is shorter than the other, a dog ear is formed at the end of the repaired wound. In the interest of overcoming these disadvantages, various surgical techniques have been developed, including rotation flaps and advancement flaps that address lesion size, location, and orientation, and adjacent soft tissue elasticity. For example, the O-Z flap commonly used to treat annular defects offers the advantage of lowering closing tension. It can be performed when sufficient tissue is available, without distorting surrounding structures4
. As with traditional rotation flaps, O-Z flap movement produces paired dog-ear redundancies near the flap's pivot points. Triple rotation flaps, especially those used in scalp reconstruction, offer the advantage of permitting distribution of tension over the surrounding tissue away from the suture lines5
. However, this results in relatively large incision lines.
This new flap has some significant advantages. It does not require the 1:3 or 1:4 length ratio normally required in elliptical excisions6
. The final length of each limb was actually approximately the same as the diameter of the defect. We were also able to apply a lazy S-plasty design7
to cylindrical areas like the arms and legs, and two limbs of the flap were directed along the relaxed skin tension line. This is useful for lesions located in areas with complex skin tension lines. Both the patients and the physicians were cosmetically satisfied with the scar lines. There were no complications, including tissue necrosis.
We suggest that the quadruple fan flap (O-X flap) is a good option for treating annular skin defects, because it shortens the scar line, preserves normal tissue, and offers a cosmetically favorable outcome.