Abstract
Complicated epidermoid cysts (ECs) occur commonly on the back, but few reports have described their management. We present our experience in managing patients with ECs on the back using a keystone-design perforator island flap (KDPIF) reconstruction, thereby focusing on reduction and redistribution of wound tension. Altogether, 15 patients (average age, 48.067 ± 14.868 years) underwent KDPIF reconstructions after complete excision of complicated ECs on the back. We retrospectively reviewed the medical records and clinical photographs of all patients. Final scar appearance was evaluated using the Patient and Observer Scar Assessment Scale (POSAS). All patients had ruptured ECs, while 6 patients also had cellulitis of the surrounding tissues. All defects, after complete excision of ECs and debridement of surrounding unhealthy tissues, were successfully covered with KDPIF. The mean ‘tension-change’ at the defect and donor sites was −4.73 ± 0.21 N and −4.88 ± 0.25 N, respectively (p < 0.001). The mean ‘rate of tension-change’ at the defect and donor sites was −69.48 ± 1.7% and −71.16 ± 1.33%, respectively (p < 0.001). All flaps survived with no postoperative complications. The mean observer scar assessment scale (OSAS) summary score and patient scar assessment scale (PSAS) total score were 14.467 ± 5.069 and 15.6 ± 6.512, respectively. Overall, we suggest that KDPIF reconstruction is a good surgical modality for the management of complicated ECs on the back.
Highlights
Epidermoid cysts (ECs) are common benign masses of the skin, and their excision is one of the most routinely performed surgical procedures[1]
Primary closure performed with a considerable amount of tension can result in persistent dead space formation owing to ineffective wound closure, which may lead to hematoma and seroma formation, wound dehiscence, delayed healing, and localised infection[6]
We retrospectively reviewed the medical records and clinical photographs of all patients who underwent keystone-design perforator island flap (KDPIF) reconstruction of defect following excision of epidermoid cysts (ECs) and evaluated the final scar appearance using the Patient and Observer Scar Assessment Scale (POSAS)
Summary
Epidermoid cysts (ECs) are common benign masses of the skin, and their excision is one of the most routinely performed surgical procedures[1]. The surgical alternatives for EC excision include puncture with aspiration, minimal excision surgery, and total excision surgery[2] The former 2 techniques are suitable for small and uncomplicated ECs2–5. In case of large-sized and complicated ECs, including those that are ruptured or infected, a total excision procedure including complete removal of the cystic components and debridement of the surrounding abnormal tissues should be performed to prevent recurrence. In such cases, which require clearance of a significant volume of adjacent tissue, it is difficult to achieve primary closure of the resultant surgical wounds[6]. Our study especially focuses on evaluating the wound tension-reducing and -redistributing effects of the KDPIF, for which we compared ‘pre-flap wound tension’ with ‘post-flap wound tension’ using an intraoperative tensiometer
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