Case ReportRhomboid flap with multiple Z-plasty for treatment of hypertrophic scar on the pubic area
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.
References (7)
- et al.
Management of hypertrophic scars on the pubic area with an iliac flap
Burns
(1991) - et al.
Pressure therapy in the treatment of post-burn hypertrophic scars: a critical look into its usefulness and fallacies by pressure monitoring
Burns
(1984) - et al.
Evaluation of various methods of treating keloids and hypertrophic scars: a 10-year follow-up study
Br J Plast Surg
(1992)
Cited by (3)
Surgical principles for achieving a functional and cosmetically acceptable scar
2013, Actas Dermo-SifiliograficasCitation Excerpt :The 7-flap Z-plasty consists of 2 half Z-plasties plus a W-M plasty (Fig. 12).32,33 Combinations of Z-plasties and rhomboidal flaps have also been described.34–37 Many of the techniques described above are triangular flaps.
Transpositional flaps
2012, Lower Extremity Soft Tissue & Cutaneous Plastic Surgery: Second EditionTreatment for protruding keloids in the pubic area with everting suture and multiple Z-plasty
2012, Journal of Tokyo Medical University