Reducing Opposed Multilobed Flap Repair, a New Technique for Managing Medium-Sized Low-Leg Defects Following Skin Cancer Surgery

Abstract

Following skin cancer excision, skin defects on the low leg between 10 and 35 mm in diameter can be problematic. Direct closure of the wound risks excessive wound tension and wound dehiscence. Skin grafts heal slowly and often remain unsightly. Traditional skin flaps have a limited role. The objective was to develop a random-pattern skin flap that offers significant advantages over traditional techniques including grafting. The reducing opposed multilobed flap involves a series of semicircular lobes extending both cephalic and caudal from the defect. The technique involves lobes most distant from the primary defect being transposed in turn closer to the defect. The technique does not result in the unnecessary excision of Burrows triangle skin. The reducing opposed multilobed (ROM) flap reduces skin tension concerns, lowers the risk of flap necrosis, and allows for quicker and more aesthetic healing. After 20 cases, we have yet to experience dehiscence, infection, or delayed healing. The healing wound is resistant to contraction and invariably produces an acceptable aesthetic outcome. The ROM flap repair allows the dermatologic surgeon an additional option when faced with a medium-sized lower leg defect following skin cancer excision.