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Windmill Flap: A New Reconstructive Option
Colgajo en molinillo de viento: una nueva opción reconstructiva
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The windmill flap technique was first described by Russo et al. back in 2022,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> from a new experimental model that measures the tensions generated at each section of the flap.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> We hereby report a series of 4 patients in whom this brand-new reconstructive technique was used.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A total of 4 patients previously diagnosed with squamous cell carcinoma referred from 3 centers with Dermatology Surgery Units were selected. The lesions were excised through outpatient surgery, under local anesthesia and/or sedation. The surgical margin planning followed the recommendations made by the American Joint Committee on Cancer (AJCC) clinical practice guidelines.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> Finally, the reconstruction of the resulting defect was performed using the windmill flap technique.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Below, we describe the flap design and surgical technique used:</p><p id="par0020" class="elsevierStylePara elsevierViewall">Flap design (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>):<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0025" class="elsevierStylePara elsevierViewall">We drew an equilateral triangle that should include the lesion and surgical margins, and labeled each of its vertices as A and the midpoint of its 3 corners as B. The distance between A and B should be projected from A to B.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0030" class="elsevierStylePara elsevierViewall">To design the 3 rotation lobes, we drew 2/6 of a circumference starting from B until it came across point B on the adjacent corner.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0035" class="elsevierStylePara elsevierViewall">Finally, we added a discharge triangle to each B point.</p></li></ul></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Surgical technique used (<a class="elsevierStyleCrossRef" href="#fig0010">figure 2</a>A-H):<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1.</span><p id="par0045" class="elsevierStylePara elsevierViewall">Once the flap was designed, our surgical technique started by removing the central equilateral triangle.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2.</span><p id="par0050" class="elsevierStylePara elsevierViewall">Afterwards, we detached each of the lobes from the surgical bed and rotated them 60° in the same direction until they came into contact with the adjacent B point, thus creating a sinusoidal pattern made by 3 different waves.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3.</span><p id="par0055" class="elsevierStylePara elsevierViewall">Finally, we connected the centers of the waves with a buried suture and moved on to suture their free edges creating a 3-helix windmill-like pattern.</p></li></ul></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Overall, 3 men and 1 woman were included, with 2 lesions located on the forehead and 2 on the scalp (<a class="elsevierStyleCrossRef" href="#fig0015">figure 3</a>). The mean age at diagnosis was 82 years (range, 74-89). The mean tumor size was 2.7<span class="elsevierStyleHsp" style=""></span>cm (range, 1.7<span class="elsevierStyleHsp" style=""></span>cm to 4<span class="elsevierStyleHsp" style=""></span>cm). There were no immediate or long-term complications resulting from the surgical technique used. The functional and aesthetic outcomes were considered satisfactory in all cases (<a class="elsevierStyleCrossRef" href="#sec0010">Appendix B. See supplementary data</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Both the forehead and the scalp are sun-exposed areas prone to multiple skin tumors. In 2017, Russo et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> conducted a study that assessed the preferred reconstructive technique for different aesthetic medicine units through a survey submitted to a group of dermatologists. The techniques selected for the scalp, central forehead, and temple were the O to Z rotation flap, the bilateral advancement flap in a flag or H shape, and the rhomboid (Limberg) transposition flap, respectively. This study stresses the need for having multiple reconstructive options available for the same location, while considering each surgeon's skills, and adapting the reconstructive technique to the individual characteristics of each patient.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Biomechanical models have demonstrated that rotation flaps like the O to Z flap generate less tension than other advancement flaps like the A to T or flag flap, thus reducing the risk of ischemia and the possibility of necrosis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Although this flap was originally designed to repair triangular surgical defects, it has proven useful to treat circular defects inscribed within a triangle.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Longer surgical times and more scars are among the main limitations of this kind of flap, although this did not result in more surgical complications.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In our series, we selected elderly patients with large lesions located in convex anatomical regions such as the forehead and the scalp. Still, the windmill flap technique can probably be used to reconstruct other defects in various locations.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In conclusion, we propose the windmill flap as a new and useful technique to reconstruct large defects in high-tension areas such as the forehead and scalp, with favorable functional and aesthetic outcomes.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0100" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix B" "titulo" => "Supplementary data" "identificador" => "sec0015" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1065 "Ancho" => 2175 "Tamanyo" => 89992 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diagram of the windmill flap design.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2750 "Ancho" => 2588 "Tamanyo" => 647780 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A-H: Detailed visual description of the reconstruction technique on porcine skin.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 743 "Ancho" => 1727 "Tamanyo" => 262954 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A: Case #1: Preoperative flap design. B: Case #1: Immediate postoperative results.</p>" ] ] 3 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 6896363 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New skin flaps for triangular surgical defects: Design, assessment on experimental model and clinical outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Russo-de la Torre" 1 => "M.E. Iglesias-Zamora" 2 => "M. Linares-Barrios" 3 => "R. Vieira" 4 => "M. Lova-Navarro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Ann Plast Surg." 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| 2024 Noviembre | 13 | 8 | 21 |
| 2024 Octubre | 173 | 70 | 243 |
| 2024 Septiembre | 140 | 47 | 187 |
| 2024 Agosto | 173 | 64 | 237 |
| 2024 Julio | 157 | 53 | 210 |
| 2024 Junio | 152 | 54 | 206 |
| 2024 Mayo | 157 | 72 | 229 |
| 2024 Abril | 163 | 58 | 221 |
| 2024 Marzo | 190 | 54 | 244 |
| 2024 Febrero | 245 | 48 | 293 |
| 2024 Enero | 92 | 60 | 152 |
| 2023 Diciembre | 66 | 72 | 138 |
