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The Double Scalpel Flap: A New Technique for the Closure of Circular Skin Defects

Kerem, Hakan MD*; Bali, Ulas MD*; Manavbasi, Yurdakul Ilker MD; Karaaltin, Mehmet Veli MD

doi: 10.1097/SCS.0b013e3182a149a6
Technical Experiences/Technical Strategies

Reconstruction needs to be designed attentively to obtain a functional and a good aesthetic consequence for closing skin defects. Numerous local flaps have been defined to conceal skin defects. However, new techniques are still required, especially for circular type of skin defects.

This study describes a new technique that has been well defined to repair the circular type of skin defects. The technique basically uses extra skin relaxation provided with 2 opposing flaps’ rotation maneuver in favor of the defect closure. The objective of this technique is for the flaps to start from one border of the defect and extend just to the other border, not invading beyond the defect borders. This enables us to apply the procedure on defects that are close to important anatomical structures because it is sufficient to use only the opposing 2 sides of the defect for its closure.

With this method, 2 opposing flaps that resemble the tip of a scalpel were rotated to the existing circular defect; and by suturing these 2 flaps at the midline, the defect was closed. This technique was applied to 17 patients between the ages of 48 and 83 years. Defect sizes were between 2.5 × 2.5 and 5 × 5 cm.

With the use of opposing flaps designed narrower than half-width of the defect, a tension-free closure could be achieved on both the donor and the recipient site. No flap necrosis was detected on any patients. After a mean follow-up of 11 months (3–26 months), it was realized that a good aesthetic appearance could be achieved in all the patients about 2 to 3 months postoperatively.

From the * Department of Plastic, Reconstructive and Esthetic Surgery, Celal Bayar University, Uncubozkoy-Manisa; †Private Practice in Istanbul; and ‡Department of Plastic, Reconstructive and Esthetic Surgery, Bezm-i Alem University, Istanbul, Turkey.

Received May 14, 2013.

Accepted for publication June 14, 2013.

Address correspondence and reprint requests to Hakan Kerem, MD, 75. Yil Mh. M.A. Ersoy Bul. No. 67/1 Manisa, Turkey; E-mail:;

The authors report no conflicts of interest.

© 2013 by Mutaz B. Habal, MD.