Slide-Swing Skin Flap

J. SCHRUDDE

V. PETROVICI

The slide-swing skin flap combines the principle of transposition with skin sliding. It can be used to close large, round defects with a flap that is smaller than the original defect (1).

In the literature, it is stated that larger defects cannot be closed by means of simple transposition flaps; multiple flaps must be used. According to our method, larger defects may be closed without any variation of the line of incision. In the case of Limberg and his followers, a generally rounded defect must be turned into a geometric figure, which inevitably results in the further excision of healthy skin. The flap must be cut exactly to the same size as the defect. Our three types of flaps allow the line of incision to be adjusted to the shape of the defect, and the flap is not only swung but slid into place.

INDICATIONS

Coverage of a round or oval defect is always difficult if the wound is large in relation to its surroundings. Among the many procedures possible, a local pedicle flap is most advantageous because it matches skin color and texture and has the potential for preserving sensibility. The slide-swing skin flap permits closure of a wound using flaps that are small in comparison to the defect. The flap is swung over as usual, with the base of the flap following in the same direction. Concurrently, the skin surrounding the defect is slid. The principle involves exploiting the displacement of the skin necessary to close the secondary defect while reducing the original defect as a result.

The slide-swing plasty may be employed on almost all parts of the body. The size of the flap is dependent on the elasticity of the skin. This is greatest in the region of the trunk, especially in the area of the flank, and in the back, abdomen, and buttocks. Skin reserves decrease in the distal regions of the limbs and are reduced on the scalp. The possibilities of closing a defect are dictated by its size and location.

The main indications for the slide-swing plasty are the defects that remain after removing tumors (see Fig. 112.3), skin dysplasias, or scars that result from injuries. To avoid distortion of facial structures in the case of larger defects, undermining of the skin and subcutaneous tissue should be undertaken mainly in the direction of the peripheral parts of the face. The slide-swing flap may be used even in places where other methods are doomed to failure. For example, the slide-swing plasty can be used on the nose and in other less elastic skin areas where pure transposition flaps require skin grafting.

FLAP DESIGN AND DIMENSIONS

A more thorough analysis of the slide-swing skin flap reveals that it is in part founded on the principles of the triangular exchange plasty (Z-plasty), the exact trigonometric rules for which were laid down by Limberg (2). The slide-swing plasty is partly a combination of two asymmetrical figures with a common median incision, also known as the basic incision. In contrast to the exchange plasty and to other methods further developed by Limberg in which all incisions were straight, all lines of incision in slide-swing flaps take the form of arcs that are partly stretched, with one exception (i.e., the initial section of the median incision that forms the bottom angle of the defect).

The additional mobilization of the skin around the defect as a part of the technique leads to a reduction in the size of the defect. Exploiting the extent of skin reserves, the flap can be cut smaller than the defect. This has the effect of reducing the size of the defect as well as the resultant scars. Unlike conventional transposition flaps and those of Limberg, incisions in our flap types are never made parallel. Instead, the flap narrows to a point. In addition, the sides of the flap are not cut to the same length, thus increasing the size of the flap base. Three basic types of flaps have been developed (Fig. 112.1).

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