Evaluation of Intraoperative Triamcinolone Injection or Primary Lobe Tacking (Pexing) Sutures for Preventing Pincushioning in Bilobed Transposition Flaps

Abstract

BACKGROUND Bilobed transposition flaps are prone to pincushioning (trapdooring), whereby contraction of the flap over the wound bed may produce an unsatisfactory functional and aesthetic outcome. There are several proposed methods to prevent this, but there is currently no clear consensus on the ideal technique. OBJECTIVE To compare primary lobe pexing sutures versus intraoperative triamcinolone (TAC) injection as methods to prevent pincushioning in bilobed transposition flaps. MATERIAL AND METHODS A retrospective chart review of bilobed flap reconstructions identified from the Mohs micrographic surgery database at a single tertiary center in New Zealand. RESULTS Three hundred forty-two patients met the inclusion criteria: 37 received pexing sutures, 42 intraoperative TAC, and 263 no additional intervention. The most defect common location was the nasal tip (43.6%), followed by the ala (20.8%). Ninety-three participants (27.2%) developed pincushioning at a median 35 days postoperatively. Participants receiving no intervention had a 30.8% pincushioning rate. The TAC group had a 23.8% pincushioning rate (p 5 .358), and the pexing group had a 5.5% pincushioning rate (p 5 .001). CONCLUSION Participants receiving primary lobe pexing sutures had a statistically significantly lower rate of pincushioning than those receiving no intervention. Intraoperative TAC injections appeared to have little impact on pincushioning.

A Challenging Defect of the Upper Nasal Bridge and Upper Nasal Sidewall

“…Two tacking sutures were placed, one at the right nasofacial sulcus and the second at the nasal root to restore normal contour. 2 The flap was then inset with the same sutures used to repair the secondary defect. The standing cone was not resected at this stage to avoid compromising the flap pedicle.…”

Radiofrequency Epilation Using Acupuncture Needles to Decrease the Disease Burden in Hidradenitis Suppurativa

“…V ideos are an increasingly popular mode of communication in both in-person and virtual educational settings. 1,2 The quality, however, is highly variable and nonuniform. Standardized videography of open-field surgical procedures is important for education and demonstration of a proper surgical technique.…”

“…Although episodes can be controlled by antibiotics, surgical treatment such as wide local excision is the definitive treatment for hidradenitis suppurativa (HS). 1,2 It decreases the area susceptible to inflammation, but it has significant morbidity for the patient and is difficult to perform.…”

Re: Evaluation of Intraoperative Triamcinolone Injection or Primary Lobe Tacking (Pexing) Sutures for Preventing Pincushioning in Bilobed Transposition Flaps

“…Although episodes can be controlled by antibiotics, surgical treatment such as wide local excision is the definitive treatment for hidradenitis suppurativa (HS). 1,2 It decreases the area susceptible to inflammation, but it has significant morbidity for the patient and is difficult to perform.…”

“…In the February issue, Boylan and colleagues 1 investigated the role that primary lobe pexing sutures or intraoperative triamcinolone injections play in reducing bilobed transposition flap pin cushioning. In this study, there was a significantly lower rate of pin cushioning when primary lobe pexing sutures were used, while intraoperative triamcinolone injections did not yield a significant benefit.…”