**2. Closure of circular skin defects**

I designed three "reciprocal incisions" in 1981 aiming to close large circular defects [6] with minimal waste of sound skin and at the same time to avoid the formation of dog ears. The first one is the *double S incision* (**Figure 1**) that is adequate for small defects in which the skin is fairly elastic. The second one is the *bow tie incision* (**Figure 2**) that is indicated in intermediate defects in which the skin is quite elastic. The third incision is the *combined V incision* (**Figure 3**) that is valuable for large defects in which the skin is fairly elastic. These incisions should be considered in view of the anatomical characteristics of the skin, such as the natural creases or the minimal tension lines. In certain cases, the surgeon quite often encounters a problem when the lesion is located in a confined anatomical area or when the

#### **Figure 1.**

*Here, the double S incision represents half of the rhombic incision which has a wastage of 103%, so the wastage of skin is reduced in half and the resultant suture line shows a mild wave shape. The vertical lines represent the minimal tension lines of the skin, and the axis X-X represents the center of these lines.*

**105**

defects in 2016 [7, 8].

**Figure 2.**

pilonidal cyst that is too low and near the anus.

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

elasticity of the skin is limited or when the lesion is too large. To obviate these problems, I published various methods for closure of circular and semicircular skin

*which eliminates the formation of dog ears. The wastage of sound skin for this incision is 36%.*

*The bow tie incision is one of the reciprocal incisions in which the length of both sides of the incision is equal,* 

For circular skin defects, two incisions were described, the *cat's ear* (**Figure 4**) and the *bird's beak* (**Figure 5**) incisions that are very versatile because they can adapt to different anatomic configurations. The first one is a modification of the *bow tie* incision and the second one is a modification of the *combined V* incision mentioned before. They require minimal dissection of the flaps and produce a relative short suture line. The cat's ear and the bird beak's incisions have the great advantage of allowing the positioning of the incision along the normal creases of the skin which will produce better cosmetic results. For instance, the bird's beak incision is very useful when dealing with a skin lesion near the eye [5] or when dealing with a

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

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

I designed three "reciprocal incisions" in 1981 aiming to close large circular defects [6] with minimal waste of sound skin and at the same time to avoid the formation of dog ears. The first one is the *double S incision* (**Figure 1**) that is adequate for small defects in which the skin is fairly elastic. The second one is the *bow tie incision* (**Figure 2**) that is indicated in intermediate defects in which the skin is quite elastic. The third incision is the *combined V incision* (**Figure 3**) that is valuable for large defects in which the skin is fairly elastic. These incisions should be considered in view of the anatomical characteristics of the skin, such as the natural creases or the minimal tension lines. In certain cases, the surgeon quite often encounters a problem when the lesion is located in a confined anatomical area or when the

*Here, the double S incision represents half of the rhombic incision which has a wastage of 103%, so the wastage of skin is reduced in half and the resultant suture line shows a mild wave shape. The vertical lines represent the* 

*minimal tension lines of the skin, and the axis X-X represents the center of these lines.*

**2. Closure of circular skin defects**

**104**

**Figure 1.**

#### **Figure 2.**

*The bow tie incision is one of the reciprocal incisions in which the length of both sides of the incision is equal, which eliminates the formation of dog ears. The wastage of sound skin for this incision is 36%.*

elasticity of the skin is limited or when the lesion is too large. To obviate these problems, I published various methods for closure of circular and semicircular skin defects in 2016 [7, 8].

For circular skin defects, two incisions were described, the *cat's ear* (**Figure 4**) and the *bird's beak* (**Figure 5**) incisions that are very versatile because they can adapt to different anatomic configurations. The first one is a modification of the *bow tie* incision and the second one is a modification of the *combined V* incision mentioned before. They require minimal dissection of the flaps and produce a relative short suture line. The cat's ear and the bird beak's incisions have the great advantage of allowing the positioning of the incision along the normal creases of the skin which will produce better cosmetic results. For instance, the bird's beak incision is very useful when dealing with a skin lesion near the eye [5] or when dealing with a pilonidal cyst that is too low and near the anus.

#### **Figure 3.**

*The combined V incision is other reciprocal incision that is very useful when trying to save sound skin, since the wastage of the skin is reduced to 0%. It could be very useful for removal of large skin lesions because the wastage of sound skin is null.*
