Rotational Skin Flap Research Articles

Ocular surface complications secondary to eyelid resection of infiltrating basal cell carcinoma

A 77-year-old female patient with the presence of a cutaneous neoformation of approximately 1 cm by 1 cm was verified at the level of the middle third and external third of the right lower palpebral eyelid, which extended to the tarsal conjunctiva of the fornix. It was decided to perform closed dacryointubation with silicone tube placement, full thickness resection of the lesion with free edges, cheek and preauricular skin rotation flap (Mustardé type) associated with autologous chondro-perichondral graft of the external ear (Matsuo type), with oral mucosa graft to restore the posterior lamella. After 15 days, the patient reports a foreign body sensation at the level of the right eye. irregularity and malposition of the lower eyelid edge, positioning abnormality of the cutaneous mucosal junction line, conjunctival hyperemia, tear breakup time of 5 seconds, tear meniscus measurement of 0.3 mm and 0.5 mm, inferior punctate epithelial keratopathy, which stains with fluorescein.

Redo surgery to improve urinary function, sexual function and cosmesis in male patients with exstrophy–epispadias complex complications. Technical principles and pearls based on case scenarios

The bladder exstrophy-epispadias complex includes some of the most challenging conditions treated by pediatric urologists. They are associated with the need for multiple intricate reconstructive procedures, aimed at restoring the anatomy and function of the bladder, urethra and external genitalia. These patients often endure multiple redo reconstructive procedures to improve urinary function, sexual function and cosmesis throughout the first two decades of life. In this article, we present the 30-year experience of a single surgeon performing redo surgery for males born with epispadias and bladder exstrophy. Through detailed documentation of 6 clinical cases, we highlight technical aspects that may contribute to a successful surgical reconstruction in these patients. The article is focused specifically on patients undergoing redo epispadias repair with or without concomitant continence procedures. We make the case for complete penile disassembly with external rotation of the corpora to correct recurrent dorsal curvature; this approach also allows the surgeon to have access to the proximal urethra and bladder neck after opening the intersymphiseal scar/band. This is useful when additional procedures on the bladder, such as bladder neck tailoring, are necessary. We also highlight the importance of avoiding reverse Byars' flaps when performing skin closure, due to the resulting midline scar. Besides being associated with a poor cosmetic outcome, it can also contribute to recurrent dorsal curvature. The authors advocate for rotational skin flaps to cover the penile shaft. Correction of dorsal curvature and improved cosmesis obtained with complete penile disassembly sometimes comes at the expense of the urethra being left as a hypospadias (figure). This will require further surgeries (usually a 2-stage buccal mucosa graft), much like the treatment of proximal hypospadias. Redo epispadias surgery in males remains a challenge. The systematic approach offered by the case scenarios may help guide surgeons dealing with this difficult condition. Patient with complications after repair of classic bladder exstrophy. A) Stone retrieved from posterior urethra after complete penile disassembly. B) After opening the inter-symphiseal scar, the bladder has been opened and the bladder neck tailored. C) Complete penile disassembly has been completed with corporal bodies and urethra individualized. D,E,F) Final appearance of the repair; abdominal wall was closed with anterior rectus sheath flaps, penile skin was closed with rotational flaps and urethra ended up as a hypospadias.

Management of complications after skin surgery relevant for melanoma in the trunk and extremities during the COVID-19 pandemic: a case series report

BackgroundPatients with melanoma have been found to be at greater risk of adverse outcomes including mortality after contacting COVID-19. Management of postsurgical complications presented additional challenges by potentially increasing exposure to COVID-19 through repeated inpatient admissions to hospital during the pandemic. We report four cases for which skin flaps, lymph ligation, and split-thickness skin graft (STSG) were successfully used in the treatment of complications in the trunk and extremities after wide local excision (WLE). This study details the operative experience in management of postsurgical complications for melanoma in the trunk and extremities during a 6-month period at the height of the COVID-19 pandemic.Case presentationWe present 4 cases detailing management of complications that occurred after wide local excisions performed for melanoma during Feb. to Oct. 2020. Case 1: A 90-year-old man who experienced wound dehiscence and necrosis on the shoulder after non-radical excision for an aggressive melanoma and underwent the side-to-side closure after ellipse formed WLE with modified tangent-to-circle method. Case 2: An 80-year-old man who had undergone excision for melanoma in his left upper arm and histopathology did not show radically. Two weeks after the excision, he underwent a WLE and direct reconstruction with double rotation skin flap. Case 3: A 55-year-old man that experienced a large wound dehiscence on his back due to WLE. He underwent an advanced double skin flap operation. Case 4: A 36-year-old woman who had a lymphorrhea and graft necrosis after WLE and STSG on the right lower leg. A combination of micro lymph ligation and re-STSG was performed. One month after the operation, all wounds had healed. There was no clinical evidence of tumor recurrence after 8 months post procedure.ConclusionsSevere complications (e.g., large wound dehiscence, necrosis, or lymphorrhea) following wide local excision of melanoma are infrequent but must be swiftly and appropriately managed, especially during the COVID-19 pandemic to decrease the likelihood of COVID-19 infection and impaired oncology outcomes from delaying systemic cancer therapy due to the complications in primary interventions.

Exstrophy epispadias complex with adenocarcinoma in adults: a case series and repair technique

The exstrophy-epispadias-complex (EEC) is a rare congenital malformation with a spectrum of abdominal-pelvic fusion abnormalities, with an incidence of 1/46,000 LB. Recurrence is 1 in100 & the male-to-female ratio is 2.3:1. Patients rarely may present in adulthood due to a lack of knowledge or financial constraints; it increases the risk of bladder carcinoma mostly adenocarcinoma or squamous carcinoma, due to chronic inflammation, infection, and metaplasia. It has a significant physical, functional, social, sexual, and psychological burden. Three patients have been operated on in our institute. A 37-year-old male, A 19-year-old male, and A 23- year-old female patient. The operation planned was a radical cystectomy with an ileal conduit and an expanded local lymphadenectomy in all three patients. The pelvis and abdominal wall defects were repaired differently post-radical cystectomy in all 3 patients using different techniques. The first patient went through primary tension closure, in the second patient bilateral rectus muscle was used as a flap and reinforced with mesh, and in the third patient, we used a rotation skin flap. All three patients were followed for 1 year. The first patient developed wound dehiscence followed by fecal fistula during follow-up and succumb due to sepsis, the second patient recovered well with a muscle flap in the postoperative period, unfortunately, developed recurrence locally and succumb due to multiple metastases, and the third patient develops flap necrosis at the tip postoperative on day 5, however, recover well after dressing, no recurrence seen on 1 year of regular follow up. As a result, the bilateral rectus flap with mesh recovers better than the rotation skin flap, which is better than primary tension closure.

Reconstruction of a Traumatic Large Upper Eyelid Avulsion with Tarsoconjunctival Graft and Rotational Flap: A Surgeon’s Preference

Introduction: Large, full-thickness upper eyelid defects management presents a thorough and challenging approach due to the multilaminar character of the eyelid and its dynamic function. The Cutler-Beard flap method has been the mainstay management, but posterior lamellar graft usage with recent modifications may reduce complications. Case Presentation: A 43-year-old man presented to the emergency ward after a traffic accident left him with a full-thickness laceration on his left upper eyelid and an approximately 60% avulsion on the one-third medial of the eyelid. Traumatic ptosis was also found. After considering the large size of the affected area and the probability of faster wound healing, a free graft from the tarsus and conjunctival eyelid of his fellow eye was harvested to replace the posterior lamellar of the affected eye and closed the defect with a rotational skin flap from the remaining of the left upper eyelid. Conclusions: This technique could be one of the alternatives to the more common cutler-beard flap with mild complications. However, temporary visual obstruction cannot be avoided due to the traumatic ptosis complication of this patient.

Adjustable Medial Epicanthoplasty Using a Rotational Flap for Epiblepharon Repair.

This report aimed to introduce the new adjustable rotational skin flap for epicanthoplasty in combination with traditional epiblepharon repair by the modified Hotz procedure. This retrospective study involved 25 consecutive patients with superficial punctate keratitis secondary to epiblepharon complicated with epicanthal fold who underwent the combined surgery between 2019 and 2020. The mean patient age was 11.4 years in this study with a median follow-up was 8months (range, 3-12months). The rationale of the surgery was to release vertical tension of the eyelids by dissecting dense connective tissue beneath the epicanthal fold and to form a new medial canthus using a rotational skin flap supplied by the redundant the upper and/or lower eyelid skin excised during the epiblepharon repair. Postsurgical resolution ofsuperficial punctate keratitis and patient satisfaction was achieved in all patients. Additionally, there were no complications, and no revisional surgery was required in all patients for a median 8 months follow-up period. Utilizing a rotational skin flap during epiblepharon repair is a useful adjunct during epicanthoplasty surgery. This modification is well tolerated and allows for intraoperative adjustment, whereas minimizing scarring and allowing for improved tissue relaxation.

The application of local rotating flap and latissimus dorsi flap in thoracic deformity correction.

Wound healing problem is one of the main complications after correction of chest wall deformity. Orthopedic flap tissue repair technique has a clear significance in non-healing wound and defect wound and provides a new choice for poor wound healing after orthopedic surgery of chest wall deformity. To investigate, the application value of modified local rotary flap and latissimus dorsi myocutcutaneous flap in the treatment of poor wound healing after orthodontic treatment of chest wall deformity. A retrospective analysis was performed on patients who admitted to our department from August 2012 to November 2019 due to non-healing incision after surgery for thoracic deformity. Skin flap was selected according to the size of the wound surface, and the effect of skin flap repair was observed. The clinical data of the included patients were recorded, and the preoperative and postoperative wound conditions were evaluated. This study included 13 patients with chest wall deformity who received plastic surgery tissue using flap technique for wound repair, 11 cases used modified local rotation skin flap, and 2 cases used modified latissimus dorsi myocutaneous flap. The mean age of the 13 patients was 18.54±4.14years old, the mean body mass index (BMI) was 17.02±2.16kg/m2 , and the mean preoperative nonunion time of the incision was 64.77±93.01days. Five patients had positive bacteria culture on the wound surface, including 3 cases of Staphylococcus aureus, 1 case of Pseudomonas aeruginosa, and 1 case of Staphylococcus epidermidis. All the 13 patients achieved primary grade A healing. The modified local rotary flap and latissimus dorsi musculocutaneous flap have a significant effect on the postoperative correction of chest wall deformity, which can ensure wound healing while retaining the orthopedic plate to the maximum extent to ensure the effect of the correction.

Les pseudarthroses infectées du tibia: évaluation de la méthode d’Ilizarov avec compression distraction sans geste de débridement local

BackgroundThe treatment of infected nonunion requires radical debridement with stable fixation. Sever soft tissue compromise of the nonunion site might interfere with radical debridement. This study discussed the outcome of treatment of infected tibial nonunion with sever soft tissue compromise by a cyclic compression distraction technique using Ilizarov without radical debridement. MethodsThis study comprised 17 patients with unilateral infected tibial nonunion; 10 with diaphyseal and 7 with metaphysial locations. Their mean age was 21.9 years. There were 12 males and 5 females. The right side was affected in 11 patients and the left side in 6 patients. According toGustilo and Anderson classification, all patients were grade III. The mean limb shortening was 1.3cm. All patients were treated initially in another institute by uniplanner external fixator with rotational skin flap done in 11 patients and thiersch graft in 6 patients. One patient had common peroneal nerve affection. Distal circulation was sufficient in all patients. None of our patients had chronic diseases. Two to three cycles of gradual distraction compression were done. Each cycle consisted of distraction, followed by compression, then distraction, and lastly compression. The mean follow up period was 29.35 months. ResultsUnion was achieved in all patients at a mean time of 23.9 weeks. According to Hammer et al.; there were 8 patients with grade 1, and 9 patients with grade 2. According to Johner and Wruhs’ criteria; the outcome was excellent in 6 patients, goodin 3 patients, poor in 4 patients, and fair in 4 patients. Complications had occurred as pin tract infection(47.1%), persistent discharging sinus (5.9%), and valgus ankle deformity (11.8%). Refracture did not occur in any case till the final follow up. ConclusionAlthough debridement is essential in the treatment of infected tibial nonunion, it could harm the limb in severe soft tissue compromise. Cyclic compression distraction by Ilizarov had a satisfactory outcome in the treatment of such cases through enhancement of a biological environment to achieve union. Level of evidenceIV; prospective case series.

Surgical repair of a full‐thickness ear pinna defect in a horse

SummaryA 5‐year‐old gelding used for showing was presented for surgical repair of a full‐thickness 15 mm diameter defect in the right pinna, which had occurred as a delayed complication following laser excision of a sarcoid. The defect had resulted in progressive deformity of the ear, and the horse was considered at risk of further injury if the defect became entrapped on a fixed object. Two artificial dermis meshes were inserted to encourage the formation of granulation tissue across the defect, and a commercially available skin expander was implanted adjacent to the site. Eighteen days later, a second surgery was performed to remove the skin expander and to mobilise a local rotational skin flap to close the defect. Both surgeries were performed under standing sedation and local anaesthesia. The site healed well, avoiding further potential trauma to the ear and deformity due to tissue contracture at the site, although some deformation of the lateral aspect of the cartilage remained.

Infected Tibial Nonunion: Assessment of compression distraction Ilizarov technique without debridement

BackgroundThe treatment of infected nonunion requires radical debridement with stable fixation. Sever soft tissue compromise of the nonunion site might interfere with radical debridement. This study discussed the outcome of treatment of infected tibial nonunion with sever soft tissue compromise by a cyclic compression distraction technique using Ilizarov without radical debridement. MethodsThis study comprised 17 patients with unilateral infected tibial nonunion; 10 with diaphyseal and 7 with metaphysial locations.Their mean age was 21.9 years. There were 12 males and 5 females. The right side was affected in 11 patients and the left side in 6 patients. According toGustilo and Anderson classification, all patients were grade III. The mean limb shortening was 1.3cm. All patients were treated initially in another institute by uniplanner external fixator with rotational skin flap done in 11 patients and thiersch graft in 6 patients. One patient had common peroneal nerve affection. Distal circulation was sufficient in all patients. None of our patients had chronic diseases. Two to three cycles of gradual distraction compression were done. Each cycle consisted of distraction, followed by compression, then distraction, and lastly compression. The mean follow up period was 29.35 months. ResultsUnion was achieved in all patients at a mean time of 23.9 weeks. According to Hammer et al.; there were 8 patients with grade 1, and 9 patients with grade 2. According to Johner and Wruhs’ criteria; the outcome was excellent in 6 patients, goodin 3 patients, poor in 4 patients, and fair in 4 patients. Complications had occurred as pin tract infection (47.1%), persistent discharging sinus (5.9%), and valgus ankle deformity (11.8%). Refracture did not occur in any case till the final follow up. ConclusionAlthough debridement is essential in the treatment of infected tibial nonunion, it could harm the limb in severe soft tissue compromise. Cyclic compression distraction by Ilizarov had a satisfactory outcome in the treatment of such cases through enhancement of a biological environment to achieve union. Level of evidenceIV; prospective case series.

Profil Darah Pada Kucing Selama Proses Kesembuhan Luka Melalui Teknik Skin Flaps Rotasi Yang Dirawat Dengan Dry Dressing Dan Moist Dressing

The skin flap is one of the techniques employed to reconstruct defects and close wounds. This study aims to observe the blood profile in cats during the healing process of rotation skin flaps that were treated with a dry and moist dressing. This study used six male cats within the age of 1-2 years old and weighed among 2-4 kg, divided into two treatment groups. All of the specimens were treated with the following procedure; the fur on the abdominal area was shaved and disinfectant was applied to the area between the os sacrum and os femur, lastly, 2 cm2 triangle wound was deliberately made on the area. The treatment of the wound was done by the rotation skin flaps method. Group 1 was treated with sterile bandage and group 2 was treated with sofratulle®. Blood samples were taken from the cephalica antebrachii vein on the 1st, 3rd, 6th, and 12th days. The erythrocytes, hemoglobin, hematocrit, platelets, leukocytes, neutrophils, basophils, eosinophils, monocytes, and lymphocytes were counted by hematology analyzer. The results showed that there is a significant difference (P<0.05) in the increase of neutrophil levels between the group treated with sterile kassa (P-1) and the group treated with sofratulle® (P-2). The number of the cats’ red blood cells rose on the 3rd day and rose again on the 12th day after the treatment with a significant difference (P<0.05) during the observation. In conclusion, the rotation flaps treatment method with dry dressing and moist dressing in the wound healing process affected the cats’ blood profile and the moist dressing was preferred to the dry dressing.

Dual-plane epicanthoplasty in Chinese blepharoplasty.

The ethnically characteristic upper eyelids of many Chinese individuals include medial epicanthal folds, substantial fatty tissue, a laxity of pretarsal skin, and a lack of superior palpebral folds. Different epicanthoplasty techniques have been described in the literature. However, postoperative medial canthal scarring remains a concern. This article introduces a novel technique that minimizes the risk of postoperative canthal scarring. Dual-plane epicanthoplasty involves an advanced skin flap and a rotation skin flap, which are, respectively, distributed on the outer skin lining and inner skin lining and belong to the different three-dimensional planes of the epicanthus. The dense connective fibers located between the skin and the orbicularis oculi muscle were completely released. In the final steps, the upper advanced triangle flap was anchored in the direction of the lacrimal caruncle and the lower rotation triangular flap was anchored to the nasal skin. From January 2016 to September 2018, 216 patients were enrolled in the cohort undergoing dual-plane epicanthoplasty, with 172 patients undergoing the concomitant double eyelidplasty. For 206 of the cases, follow-up lasted for over 6months, with a median time of 11months. Except for one patient (0.49%) who may need a revision procedure for a prominent scar, all other patients (99.51%) achieved natural and cosmetically desirable appearances with adequate lacrimal caruncle exposure and minimal postoperative medial canthal scaring. Dual-plane epicanthoplasty, with or without double eyelidplasty, is a novel and effective surgical technique modified for Chinese patients with good esthetic outcomes.

Platelet-Rich Plasma Enhances Distal Flap Viability and Underlying Vascularity in a Radiated Rotational Flap Rodent Model.

Importance: Autologous platelet-rich plasma (PRP) has received widespread attention due to its physiologic healing properties, augmenting the body's natural healing process through platelet activation and release of growth factors. The effects of PRP on radiated tissue have been inadequately studied in vivo. Objective: To determine whether PRP can be used to improve viability of radiated tissue subjected to a clinically meaningful stressor, in this case a rotational skin flap. Design, Setting, Participants: This is a prospective trial using a radiated rat abdominal rotational flap model in the laboratory. Male Sprague-Daley rats were used in this study. Harvested PRP or saline control was injected into rotational flaps immediately after surgery. Progression of necrosis was documented with photo analysis. After 1 week, animals were sacrificed and flap tissue was stained and analyzed for presence of vascular tissue. Intervention: PRP versus control injection into radiated skin tissue. Main Outcomes and Measures: Percentage necrosis of rotational flap and number of vascular channels stained with CD31 present in flap tissue. Results: PRP administration helped rescue the distal flap from necrosis, achieving viability similar to nonradiated controls. Superficial vascularity was similarly increased fivefold in radiated tissue if PRP was given postoperatively, mirroring the vascular density of nonradiated tissue. Conclusions and Relevance: PRP may enhance distal rotational flap viability after radiation, possibly by protecting superficial vessels from tissue necrosis when administered at the time of surgery.

Different Designs of Skin Closure of Spina Bifida Aperta: An Institutional Experience of Case Series

Background Data: Failure of closure of the caudal end of the neural tube is believed to be the embryological cause of spina bifida. Surgical repair is the ultimate solution and consists of multiple steps. Skin closure is the final and main step and is essential for a successful repair. We focused on different types of skin closure in the current study. Purpose: To set predictive factors for selecting different types of skin closure in the closure of spina bifida aperta. Study Design: A retrospective case study. Patients and Methods: Between April 2016 and April 2017, 30 patients (16 males and 14 females) who underwent surgical intervention for spina bifida aperta were reported. Twenty-four patients (80%) had myelomeningocele, 3 patients (10%) meningocele, and 3 patients (10%) myeloschisis. The types of skin closure designs were recorded and evaluated. Moreover, the factors that can affect designing the skin closure presented in this study were reported and evaluated retrospectively. Results: In this series, 60% (N = 18) of the patients underwent primary closure, 13.3% (N = 4) closure by using double transpositional skin flaps, and 26.6% (N = 8) skin closure using double rotational skin flaps. Conclusion: The data of this study may suggest that, in patients with spina bifida aperta, selection of the primary direct skin closure and skin flap closure is a significant predictor of the final outcome. The presence of a pedicle and the size of the mass in relation to the back were significant outcome factors, while the shape of the defect was not a significant outcome factor. (2020ESJ207)

The Use of Bi-lobed Rotational Flap to Cover Large Body Defects: Two Clinical Cases

The bi-lobed skin rotational flaps are commonly used mainly to cover facial tissue defects on the nasal tip and dorsal side, also on head areas, where skin and surrounding tissues are tight. Recent literature shows that the bi-lobed flap is used to cover defects in other body areas as well.This report shows two clinical cases where the bi-lobed flap was used to cover large skin and soft tissue defects after the excision of pathologically damaged skin and soft tissue lesions of the popliteal and the chest area. In both cases the recipient areas were adequately covered, and donor sites were closed primarily.

Multicentre, randomised trial comparing acellular porcine collagen implant versus gluteus maximus myocutaneous flap for reconstruction of the pelvic floor after extended abdominoperineal excision of rectum: study protocol for the Nordic Extended Abdominoperineal Excision (NEAPE) study

IntroductionDifferent surgical techniques are used to cover the defect in the floor of the lesser pelvis after an ‘extralevator’ or ‘extended’ abdominoperineal excision for advanced rectal cancer. However, these operations...

Novel technique to manage pacemaker exposure with buried flap reconstruction: case series

ObjectiveExposure of implantable electrical devices may increase morbidity and mortality significantly. Usually superficial infections are conservatively managed whereas invasive infections necessitate complete capsulectomy, sub-pectoral placement or implant exchange. Most commonly...

Adjacent skin rotation flap for large defect in primary breast tumor.

Surgical resection of large primary breast tumor often results in large chest wall defects. The purpose of this study is to evaluate the feasibility of using adjacent skin rotation (ASR) flap in patients with giant primary breast tumor. A total of 26 giant primary breast tumor patients treated with ASR flap were included in this study. The postoperative conditions, including operating time, blood loss, length of hospital stay, and clinical complications were observed. Meanwhile, the information on 17 breast tumor patients treated with transverse rectus abdominis myocutaneous (TRAM) flap were collected and assigned to a control group. The mean defect size after mastectomy was 16.7 × 13.4 cm, while the median follow-up period was 13 months after surgery. A total of 15.4% patients had developed with local complications, and one of them had more than one complication. When comparing the postoperative outcomes, statistically significant differences were found between the two groups with respect to operating time, blood loss, and length of hospital stay (P < 0.001). ASR flap is a reliable technique for immediate reconstruction of massive chest wall defects in patients with giant primary breast tumor.

Management of Urethral Lesions and Urethrovaginal Fistula Formation Following Placement of a Tension-Free Suburethral Sling: Evaluation From a University Continence and Pelvic Floor Centre.

Introduction The complication of tape erosion in the urethra following placement of a retropubic (TVT) or transobturator (TOT) tension-free suburethral vaginal sling or an accidental iatrogenic transurethral tape position can result in the formation of a urethrovaginal or vesicovaginal fistula. The objective of the investigation is the evaluation of the management of such rare complications. Patients and Methods Retrospective analysis of 14 patients who were treated for a urethral lesion or urethrovaginal fistula formation status post TVT/TOT placement between June 2011 and February 2018 in the Tübingen University Department of Gynaecology. Results As surgical therapy, 57.1% (n = 8) cases underwent vaginal fistula closure using a Martius flap of the labium majus and in 21.4% (n = 3) using a vaginal rotation skin flap. In 21.4% (n = 3), exclusively vaginal suture reconstruction of the urethra following excision of the tape running transurethrally or tape erosion was performed. 50% (n = 7) of the patients had lasting continence postoperatively without any further need for therapy. In 28.6% (n = 4), there was ongoing stress urinary incontinence, in 21.4% (n = 3) mixed urinary incontinence. Six of the 7 patients with persistent incontinence underwent new placement of a tension-free suburethral retropubic sling (TVT) an average of 8.8 months (5 – 13 months) postoperatively which was uncomplicated in all patients and achieved satisfactory continence. The 3 patients with mixed urinary incontinence and persistent urgency components additionally received anticholinergic medication. During the time period investigated, there were no long-term complications, in particular no recurrent fistulas. Conclusion The rare but relevant complications of a urethral erosion, transurethral tape position or urethrovaginal fistula formation status post TVT/TOT placement can be successfully managed via vaginal surgery. Persistent postoperative urinary incontinence with the need for a two-phase repeat TVT placement following sufficient wound healing must be preoperatively clarified.

Epidermal inclusion cyst with foreign-body giant-cell reaction treated with surgical excision and rotational flap closure: A case report

Epidermal inclusion cysts (epidermoid cysts) occur from penetration of epidermal cells into underlying dermal tissue. They are most commonly found on the scalp, face, neck, and back with a reported incidence of 10% on the extremities. We present the case of a 53-year-old female who presented with complaint of a painful plantar forefoot soft-tissue mass of insidious origin. After magnetic resonance imaging, she was treated with surgical excision and plastic rotational flap closure. The surgical site healed without incident, and she was able to ambulate pain free in her normal footwear with full weight bearing and no shoe modifications or orthotics. This case was novel in that the size of the lesion required the use of a uni-lobe full-thickness rotational skin flap to achieve complete tension-free closure.