Evaluation of Intraoperative Triamcinolone Injection or Primary Lobe Tacking (Pexing) Sutures for Preventing Pincushioning in Bilobed Transposition Flaps.

Abstract

Bilobed transposition flaps are prone to pincushioning (trapdooring), whereby contraction of the flap over the wound bed may produce an unsatisfactory functional and aesthetic outcome. There are several proposed methods to prevent this, but there is currently no clear consensus on the ideal technique. To compare primary lobe pexing sutures versus intraoperative triamcinolone (TAC) injection as methods to prevent pincushioning in bilobed transposition flaps. A retrospective chart review of bilobed flap reconstructions identified from the Mohs micrographic surgery database at a single tertiary center in New Zealand. Three hundred forty-two patients met the inclusion criteria: 37 received pexing sutures, 42 intraoperative TAC, and 263 no additional intervention. The most defect common location was the nasal tip (43.6%), followed by the ala (20.8%). Ninety-three participants (27.2%) developed pincushioning at a median 35 days postoperatively. Participants receiving no intervention had a 30.8% pincushioning rate. The TAC group had a 23.8% pincushioning rate (p = .358), and the pexing group had a 5.5% pincushioning rate (p = .001). Participants receiving primary lobe pexing sutures had a statistically significantly lower rate of pincushioning than those receiving no intervention. Intraoperative TAC injections appeared to have little impact on pincushioning.