Skin grafts have long been a mainstay in the reconstruction of skin cancer excision defects. Sun-exposed areas such as the head and neck, as well as the upper and lower extremities, are common sites for skin cancer and, therefore, postexcision reconstruction. In particular, the anterior tibial area can present difficulties in reconstruction given the paucity and inelasticity of skin anterior to the tibia. As a result, full-thickness skin grafts have been a useful tool in reconstructing skin cancer excision defects in the pretibial area. Historically, the groin has served as a common donor site. Although it is still a good option, the donor-site scar can be long and unsightly, given that skin cancer excision defects are frequently circular (especially melanoma) and the donor site is designed elliptically to achieve a linear closure.
We propose the use of a periumbilical donor site for reconstruction of pretibial skin cancer excision defects. The advantages of such a donor site are as follows: (1) the periumbilical donor site supplies skin in a circular pattern ideal for filling the circular pretibial defect; (2) there is a good color match between the pretibial and periumbilical skin; and (3) the resultant periumbilical scar is well hidden.
A doughnut-shaped area around the umbilicus is marked out, leaving a small, superiorly based skin bridge intact (Fig. 1). The skin is excised full thickness and thinned appropriately. The skin is then sutured into the defect with primary closure of the central hole, with very little trimming or tailoring necessary (Fig. 2). The donor site is closed in a purse-string fashion using a permanent suture to avoid widening of the scar, much like a Benelli blocking suture.1
The periumbilical donor site has proven to be a useful tool in the full-thickness skin grafting of pretibial skin cancer excision defects (Fig. 2), particularly in patients concerned with cosmesis. The graft allows for easy in-setting into the defect because of its circular nature, it provides a color match similar to that of pretibial skin (Fig. 2), and it leaves the patient with a well-camouflaged donor scar (Fig. 1). It provides yet another weapon in the armamentarium available to plastic surgeons who often deal with full-thickness, circular pretibial defects.
Karl Schwarz, M.S., M.D.
Steven P. Davison, D.D.S., M.D.
Department of Plastic Surgery
Georgetown University Hospital
1. Benelli, L. A new periareloar mammaplasty: The round block technique. Aesthetic Plast. Surg.
14: 93, 1990.
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