A s dermatologists, most of us are treating skin cancer regularly because of the rising incidence of non-melanoma skin cancer in the United States.1 And, some wounds left by the extirpation of skin cancers are more difficult to close in a cosmetically effective way. This article, part two in a two-part series, describes additional options for closing these wounds.
Simplifications range from the fundamental to the more advanced. Last month we discussed primary closure/ flaps, incomplete closure (second intention healing), inclusion of Burrow’s triangles in the defect, partial closure and flaps A.R.T. In this article, we will discuss contiguous island grafting, combining flaps with grafts and multiple skin cancers in the same surgical field.

Partial Closure/ Graft
In this example, the wound is made smaller through partial closure but this smaller wound is then covered with a modified full-thickness graft. A nice example of this procedure is the “contiguous island graft.”2 Contiguous grafts are versatile and create only one wound as opposed to distant grafts, which have the two wounds including the primary defect and the donor site.

Flap Partial Closure/ Island Graft
In this case, the wound is made smaller by a flap and the remaining defect is closed by a graft. This graft is much smaller than would be needed if the wound had not been partially closed by the flap.

Multiple cancers
Many of the patients who are ravaged by the skin cancer epidemic present with multiple cancers on the same surgical field. Often times, the defects from these cancers can be closed by a geometric system of flaps leading to a natural appearing and cosmetically elegant scar.

Know Your Options
It is worthwhile for dermatologic surgeons to study a variety of wound closure designs to
better serve their patients. The simplifications discussed in this article series certainly allow dermatologists an effective “menu” of operative choices, which, ultimately, knowledgeable surgeons will tailor to their needs.