“Reading Man Flap” Design for Reconstruction of Circular Infraorbital and Malar Skin Defects

A banner flap with adjacent rotation flap for closure of circular skin defects: a schematic comparison with conventional rotation flap technique

The local flap method is a minimally invasive, quick, and common technique of closing skin defects. Several methods using multiple local flaps are employed for the purpose of closing relatively large defects, and minimizing the resultant scar and deformity. We present a combined local flap method using a banner flap with an adjacent rotation flap (B-R flap) with the potential for closing circular defects. A retrospective analysis was performed in 15 patients treated with the B-R flap for circular skin defects over a 2-year period. The sizes of the flap and the healthy skin excision area were evaluated using image analysis software, and were compared to a model of a conventional rotation flap that would be necessary to close the same defect. All flaps were successfully engrafted. The B-R flap required a 39.1% smaller rotation flap and an 85.9% smaller area of healthy skin compared to the conventional rotation flap technique. There was one adverse event, partial epidermal necrosis that was conservatively treated and healed. The B-R flap is comparatively less invasive; it allows a smaller area of healthy skin to be excised. It can be a useful option for closing a circular defect.

Reading man flap: application to plantar defects

The plantar surface of the foot has highly specialized, densely adherent, glabrous skin, making functional replacement difficult. Glabrous skin defects should be replaced with similar skin to restore function and aesthetics. An innovative technique, the "reading man flap," was developed for closure of circular skin defects. At locations such as the face, trunk, thigh, and calf, the "reading man" procedure provides tension-free closure with minimal additional healthy skin excision, and it does not cause "dog ear" formation. The potential exists for replacement of plantar defects with skin of the same quality using this procedure. In the present study, we report on 2 clinical cases in which intermediate-size plantar defects were reconstructed using the reading man flap. This method can provide tissue as durable, yet as sensitive, as skin that matches the unique characteristics of the plantar skin.

The 'reading man flap' for pressure sore reconstruction

Background:

The treatment of pressure sores represents a significant challenge to health care professionals. Although, pressure wound management demands a multidisciplinary approach, soft tissue defects requiring reconstruction are often considered for surgical management. Myocutaneous and fasciocutaneous flaps can provide stable coverage of pressure sores.

Purpose:

Here, we describe our experience using a recent fasciocutaneous flap, which is named ‘reading man’ flap, in sacral, ischial, and trochanteric pressure sores.

Materials and Methods:

During a period of 1 year the authors operated 16 patients, 11 men, and 5 women, using the reading man flap. The ages of the patients ranged from 24 to 78 years. The location of pressure sores was 8 sacral, 5 ischial, and 3 trochanteric pressure sores. The mean size of pressure sores was 8 cm × 9 cm.

Results:

All pressure sores covered bt the Reading Man flap healed asymptomatically. After follow-up of 2-8 months, no recurrences were encountered and no further surgical intervention was required.

Conclusion:

The reading man flap was found to be a useful technique for the closure of pressure sore in different anatomic locations. The advantage of tension-free closure and the minimal additional healthy skin excision made this flap a useful tool in pressure sore reconstructions.