Three Point-Advancement Closure for Skin Defects

Abstract

Large wounds may be closed with the advantage of avoidance of larger flaps, of decreased wound healing compared to second intention, and of minimizing removal of healthy tissue. An initial trial of closure with this method does not limit subsequent use of other repairs should it be less than satisfactory.

Triple Advancement Flap to Repair an Upper Lip Defect

“…This flap allows the surgeon to recruit tissue and spread tension over multiple vectors. 1 It is particularly useful in areas of bifurcation or trifurcation of contour and tension lines. Skin closure lines are kept in the lines of minimal tension and a threesided closure is made instead of a two-sided closure.…”

“…1 To determine the best three sites for suture placement, three skin hooks may be placed in distant points of the wound followed by pulling toward the center. Several combinations of points along the wound edge may be tested in this manner.…”

The Mercedes flap and its new variants: a ‘workhorse’ flap for the dermatological surgeon?

“…For these regions, the combination of a purse string suture, dog ear repair and multidirectional advancement flap with V‐Y plasty leading to a stellate or ‘Mercedes’ flap is a very good alternative, compared to other options. This kind of closure was first described by Tamir et al ., who demonstrated that circular wounds can be easily closed using this technique, creating well tolerated, favourable results, even with larger wounds, avoiding extensive flaps or healing by second intention . Literature concerning the stellate purse string suture and the Mercedes flap is generally very sparse.…”

“…This kind of closure was first described by Tamir et al, who demonstrated that circular wounds can be easily closed using this technique, creating well tolerated, favourable results, even with larger wounds, avoiding extensive flaps or healing by second intention. 3 Literature concerning the stellate purse string suture and the Mercedes flap is generally very sparse. Dang et al, demonstrated that a defect of about 1.5 cm on the vertex of the scalp is easily closed with a stellate purse string suture with four points and one buried subcuticular suture.…”

The Mercedes flap: a modified closure for circular skin defects around the eyebrow

“…This closure may distort the tissue around the eyebrow, making the eyebrows asymmetrical . Furthermore, although a purse‐string suture can be used to provide closure for a circular skin defect around the eyebrows, this method will pull all the skin around the defect to the centre, producing puckering and buckling of the skin . An alternative method of closure for circular skin defects around the eyebrow is the Mercedes flap, which involves excision of less of the healthy tissue and requires less tissue to be pulled to the centre of the defect, making the scar less visible.…”