The spider procedure: a new Z-plasty-based local flap procedure.

Abstract

Using neighboring similar skin, local flap procedures provide optimal aesthetic and functional results in reconstruction of skin defects. Therefore, a number of local flap procedures have been described. However, as skin defects present limitless variations in size and shape, new flap procedures are still needed. Here, we describe a new Z-plasty-based local flap technique, "the spider procedure," for closure of the skin defects. In this procedure, first, the existing defect is surgically converted to a triangle in shape. Then, using a modified 5-flap Z-plasty pattern, the flaps are outlined. By transposing the elevated flaps in a Z-plasty manner, a tension-free closure is achieved by means of tissue relaxation provided by opposing Z-plasties. Over 9 years, this technique has been used for closure of various skin defects in 42 patients (19 men and 23 women) aged 17 to 57 years. This procedure was used for facial defects in 20 patients, abdominal defects in 6, upper extremity defects in 7, and lower extremity defects in 9 other patients. The defect size ranged between 1.5 and 17 cm in diameter. A tension-free defect closure was obtained in all patients. Except 2 patients with minor flap tip necrosis who underwent secondary healing, all patients healed uneventfully and no patient required revision surgery in our series. There was no patient with dog-ear formation. A mean follow-up of 2 years (6 months-9 years) revealed an aesthetically acceptable scar formation in all patients. On the basis of our clinical results, the spider procedure seems to be a useful alternative for the closure of various skin defects in all regions of the body. Using the advantage of extra tissue relaxation provided by opposing Z-plasties, it enables a surgeon to obtain tension-free closure of considerably large skin defects without dog-ear formation.