Scar-Saving Flap during Serial Excision by Borrowing from the Opposite Side.

Background: Congenital melanocytic nevi may have various shapes according to the anatomic location. Therefore, it is desirable to apply proper surgical designs to the diverse forms considering the characteristics of the sites as well as the shape and size.

Objective: The purpose of this article is to introduce a new scar-saving flap design for semicircular defects after removing congenital melanocytic nevi without excising additional normal skin.

Methods: In most cases to excise semicircular nevi, normal skin should be excised to prevent dog ear, resulting in the long length of the scar. So we use a new scar-saving flap design by borrowing a partial length from the opposite side.

Results: We used this new technique for 4 cases of large semicircular skin defects. In all cases, this method had some advantages from this perspective: (1) it does not require excision of normal adjacent skin to convert a semicircular defect into a crescent shape or to remove dog-ears (2) the final suture line is not much longer than the diameter of the original defect and (3) it makes the removal of a much larger volume possible in one procedure rather than using the classic serial excision technique, which consists of a central elliptical excision within the confines of the nevus. In this way the frequency of procedures and discomfort to the patient can be reduced.

Conclusion: We think that a scar-saving flap design by borrowing a partial length from the opposite side can be a good strategy for a semicircular skin defect.