Case Report
Rhomboid flap with multiple Z-plasty for treatment of hypertrophic scar on the pubic area

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Summary

The pubic area is prone to the development of hypertrophic scars; however, few studies have reported on the valid means of treating hypertrophic scars affecting this area. We have recently devised a new operative procedure, ‘rhomboid flap with multiple Z-plasty’, for the treatment of this condition. For this operative procedure, the defect after resection of the scarred tissue in the pubic area is first covered with a rhomboid flap elevated from the hypogastric area, followed by applying multiple Z-plasty to the suture wound of the donor site. By avoiding excessive suturing of the defect in the pubic area, and by covering the defect with a rhomboid flap, the tension on the wound margin can be sufficiently reduced. This is followed by multiple Z-plasty for the longitudinal wound of the hypogastric area, erasing all suture lines perpendicular to the natural folds. Here, we report two cases that underwent this procedure with favourable outcomes.

Section snippets

Surgical procedure

First, a rhomboid is rendered as surrounding the pubic area affected by the hypertrophic scar. Then, a rhomboid flap to close the defect after scar resection is designed on the hypogastric area (Figure 1). If the hypertrophic scar also affects the hypogastric area contiguous to the pubic area, the hypogastric scar is resected simultaneously. Resection is confined to the scarred tissue, preserving the underlying fat tissue as much as possible. Then, a rhomboid flap with sufficient thickness is

Case 1

A 55-year-old woman, who had undergone resection of an ovarian tumour 12 years ago, showed development of the postoperative wound into a hypertrophic scar. Her subjective symptoms were an itching sensation and pain in the scarred area. At our facility, the hypertrophic scars in the pubic area and the hypogastric area were removed, and the resultant defects were covered with the rhomboid flap. The longitudinal wound after suturing of the flap donor site was additionally subjected to multiple

Discussion

The pubic area is prone to the development of keloids. In the course of our gynaecologic practice, we often encounter cases where the wounds remaining after burns or injury develop into hypertrophic scars. The treatment of hypertrophic scars in this area is very difficult.

The treatment of hypertrophic scars can be generally divided into conservative and surgical treatments.2, 3, 4, 5, 6, 7 Compressive therapy is the principal method of conservative treatment. Using this method, the scar can be

Conflict of interest

None.

Funding

None.

Acknowledgement

We thank Dr. Yousuke Ando for his kind advice and assistance in the preparation of the article.

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