BACKGROUND. The advancement flap involves the linear advancement of tissue in one direction. Despite its straightforwardness and simple concept, it can be used to close a variety of defects, ranging from small defects on the scalp or extremities to large, complicated defects involving cosmetic units on the face.

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Cutaneous tuberculosis is rarely seen in the United States, and we are unaware of any reports of siblings sharing the diagnosis. We report an instance of cutaneous tuberculosis affecting two sisters. The first sibling had skin biopsy specimen findings suggestive of an infectious source, but special stains and cultures were negative. Only with further evaluation using polymerase chain reaction (PCR) was the diagnosis established. The second sibling had positive staining for acid-fast bacilli, though her cultures were also negative. A high level of suspicion for tuberculosis should be maintained in otherwise healthy children with nonspecific, granulomatous disorders of the skin. PCR may be a useful tool for selected cases in which a high level of clinical suspicion exists, but special stains and cultures are negative.

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