**6. Indications**

Any of the incisions described in this article can be selected to accommodate to the characteristics of a particular anatomical region. For instance, the **double S incision** (**Figure 1**) is indicated for closure of multiple small skin defects of the face and other parts of the body. This incision is useful in small defects of the scalp (>1 cm in diameter) and moderate defects of the face (2–3 cm in diameter).

The **bow tie incision** (**Figure 2**) is very useful when the skin is not quite elastic, such as in small defects of the scalp (1–2 cm in diameter), because the waste of sound skin for this incision is 36% only. For the same season, it is very useful in very large lesions of the trunk (5–10 cm in diameter).

**Figure 7.**

*The goblet incision is similar to the half-moon incision, but is more robust and saves more sound skin (19%).*

The **combined V incision** (**Figure 3**) is indicated in very large defects of the scalp (more than 2 cm in diameter) because with this incision there is no wastage of normal skin. For the same reason, it is very useful in very large lesions of the thorax and abdomen where saving of sound skin is important.

The **cat's ear** and the **bird's beak incisions** (**Figures 4** and **5** ) are very convenient for closure of large lesions of the face near the eye and nose where the elasticity of the skin is poor and where a good cosmetic result is desired. These two incisions can be aligned following the natural creases of the skin so there is no distortion of the periorbital area or nose.

The **cat's ear** incision would be very useful in closing the skin defect after a radical mastectomy to prevent the formation of a large dog ear at the dorsal end of the incision. In this situation, the ear portion should point to the sternum and the complementary extension, below the axilla, eliminates the extension of the elliptical incision toward the back.

The **bird's beak incision** is very useful when dealing with a pilonidal cyst that is too low and near the anus. In this case, the beak should point upward and to the midline and the additional incision can be placed on either side at the lower side of the defect.

**111**

**Figure 8.**

suture line in the middle of the defect.

*or elliptical incisions (103% and 156%, respectively).*

gular defects of the infraorbital region.

*Designing Flaps for Closure of a Variety of Skin Defects DOI: http://dx.doi.org/10.5772/intechopen.89547*

The **half-moon** and the **goblet** incisions (**Figures 6** and **7** ) are indicated when the lesions have the same shape and when the surrounding skin is very scarce such as in the case of large meningoceles because the wastage of sound skin is minimal (29 and 19%, respectively). They are also indicated when dealing with large pressure ulcers of the sacral area or when dealing with pilonidal cysts where the defect should be closed with wide base flaps that should cover the skin defects avoiding a

*meningoceles or when resecting pilonidal sinuses or when removing triangular defects of the infraorbital region. However, the wastage of sound skin for this incision is 100%, but this is better than the wastage of the rhomboid* 

*The equilateral triangular incision is useful for lesions of similar shape, for instance when repairing* 

The **triangular incisions** (**Figures 8** and **9**) are indicated when the skin lesions have a similar shape, and when the skin defect has to be covered with a suture line away from the central portion of the defect, such as in the case of large meningoceles. In these cases, the skin can be mobilized without compromising their blood supply since these incisions are provided with wide based flaps. These triangular incisions are also useful when resecting pilonidal sinuses or when removing trian*Designing Flaps for Closure of a Variety of Skin Defects DOI: http://dx.doi.org/10.5772/intechopen.89547*

#### **Figure 8.**

*Trauma and Emergency Surgery - The Role of Damage Control Surgery*

The **combined V incision** (**Figure 3**) is indicated in very large defects of the scalp (more than 2 cm in diameter) because with this incision there is no wastage of normal skin. For the same reason, it is very useful in very large lesions of the thorax

*The goblet incision is similar to the half-moon incision, but is more robust and saves more sound skin (19%).*

The **cat's ear** and the **bird's beak incisions** (**Figures 4** and **5** ) are very convenient for closure of large lesions of the face near the eye and nose where the elasticity of the skin is poor and where a good cosmetic result is desired. These two incisions can be aligned following the natural creases of the skin so there is no distortion of the

The **bird's beak incision** is very useful when dealing with a pilonidal cyst that is too low and near the anus. In this case, the beak should point upward and to the midline and the additional incision can be placed on either side at the lower side of the defect.

The **cat's ear** incision would be very useful in closing the skin defect after a radical mastectomy to prevent the formation of a large dog ear at the dorsal end of the incision. In this situation, the ear portion should point to the sternum and the complementary extension, below the axilla, eliminates the extension of the ellipti-

and abdomen where saving of sound skin is important.

**110**

periorbital area or nose.

**Figure 7.**

cal incision toward the back.

*The equilateral triangular incision is useful for lesions of similar shape, for instance when repairing meningoceles or when resecting pilonidal sinuses or when removing triangular defects of the infraorbital region. However, the wastage of sound skin for this incision is 100%, but this is better than the wastage of the rhomboid or elliptical incisions (103% and 156%, respectively).*

The **half-moon** and the **goblet** incisions (**Figures 6** and **7** ) are indicated when the lesions have the same shape and when the surrounding skin is very scarce such as in the case of large meningoceles because the wastage of sound skin is minimal (29 and 19%, respectively). They are also indicated when dealing with large pressure ulcers of the sacral area or when dealing with pilonidal cysts where the defect should be closed with wide base flaps that should cover the skin defects avoiding a suture line in the middle of the defect.

The **triangular incisions** (**Figures 8** and **9**) are indicated when the skin lesions have a similar shape, and when the skin defect has to be covered with a suture line away from the central portion of the defect, such as in the case of large meningoceles. In these cases, the skin can be mobilized without compromising their blood supply since these incisions are provided with wide based flaps. These triangular incisions are also useful when resecting pilonidal sinuses or when removing triangular defects of the infraorbital region.

#### **Figure 9.**

*The isosceles triangular incision is useful when excising lesions of similar shape, for instance pilonidal cysts or pressure ulcers of the sacral area. The wastage of sound skin is 71.4%.*

The **oval** and the **elongated hexagonal** (**Figures 10** and **11**) incisions are indicated when the skin lesions have a similar shape and when there is not enough room for extension of the incision at the ends. Besides this, the wastage of normal skin for both incisions is essentially null.
