“Flap-to-defect” concept for closure of circular skin defects: the ice cream cone flap

Abstract

While sliding-type skin flaps such as advancement and rotation flaps are useful for closing circular skin defects that are too large to close primarily, these flaps are associated with some technical difficulties that must be overcome. In this study, we aimed to present our clinical experience using an alternative curvilinear advancement-transposition flap designed based upon a “flap-to-defect” concept. A retrospective review was conducted of patient charts and operative photographs of all “ice cream cone flaps” performed at the Department of Plastic and Reconstructive Surgery between May 2014 and November 2018. This method, for the repair of circular-shaped wounds, is intended to allow appropriate distribution of closure tension without necessitating changing the shape of the defect. Patient age, gender, defect size and region, postoperative complications, and esthetic/functional satisfaction were evaluated. The technique, based on the planning of a curvilinear advancement flap that mirrors the defect, was used for reconstruction of circular skin defects that involved various parts of the body. Information from 30 patients with defects ranging from 100 × 70 to 20 × 20 mm with a mean diameter of 30.3 × 20.8 mm were reviewed for the study. All flaps survived without wound infection, hematoma, or flap necrosis complications. During the follow-up period, acceptable esthetic results were achieved. This technique is a good alternative for the closure of small to moderate circular skin defects where adequate skin laxity is present. Level of evidence: Level IV, therapeutic study.