PMC5921446_01
Triple rotation planned with wide excision of tumor
JCAS-11-26-g001.jpg
PMC5921446_01_JCAS-11-26-g001.jpg
F1
Lesion was excised with inclusion of 1-cm margin of clinically normal tissue [Figure 1].
Primary defect formed after excision along with three flaps being raised around the defect
JCAS-11-26-g002.jpg
PMC5921446_01_JCAS-11-26-g002.jpg
F2
Around the primary defect, three flaps were raised by marking an arc around the defect, length of the arc being 1.5 times the diameter of the defect and the angle of the arc was 30 -50  [Figure 2].
Three flaps rotated into the defect with three secondary defects formed
JCAS-11-26-g003.jpg
PMC5921446_01_JCAS-11-26-g003.jpg
F3
With good undermining, the three arcs were rotated into the defect and sutured at the center subdermally with Vicryl 3-0 (Ethicon, Somerville, New Jersey) [Figure 3].
Three flaps being closed in a fan-shaped pattern
JCAS-11-26-g004.jpg
PMC5921446_01_JCAS-11-26-g004.jpg
F4
The three secondary defects were closed using Prolene 3-0 (Ethicon, Somerville, New Jersey) so that the suture line resembled a fan-shaped pattern [Figure 4].