DS08 An evaluation of the efficacy of intraoperative triamcinolone injection, primary lobe pexing sutures or no intervention for preventing pincushioning in bilobed transposition flaps

Abstract

A well-documented and frustrating complication of the bilobed flap is pin cushioning, which may impair functional and aesthetic outcomes. Several authors have proposed strategies to minimize pincushioning, although there is currently no clear consensus on how to best prevent it. Approaches utilized by Mohs surgeons at a single institution have been either an intraoperative steroid injection of triamcinolone (TAC) into the primary lobe of the flap or pexing sutures to anchor the primary lobe to the wound bed. This single-centre retrospective chart review study compares the relative efficacy of both techniques. Normally distributed continuous variables were compared using the two-tailed Student’s t-test, and non-normally distributed variables were compared using two-tailed Mann–Whitney testing. Categorical data were compared using the two-tailed χ2-test and two-tailed Fisher’s exact test when required. P-values < 0.05 were considered statistically significant. In total, 342 cases were included in the statistical analysis: 37 received pexing sutures, 42 received intraoperative TAC injections and 263 received neither. The most common site for cancers was the nasal tip (43.6%), followed by the ala (20.8%) and sidewall (16.4%). The distribution of cancer locations was consistent across all subgroups. The average surgical defect size to be reconstructed was 1.31 cm2. This did not vary significantly between groups. There were 93 (27.2%) recorded cases of pincushioning, occurring at a median of 35 days postoperatively. The TAC intervention group had a lower rate, with 24% of patients (n = 10) developing pincushioning, but this was not a statistically significant reduction (P = 0.36). The pexing group demonstrated a far greater reduction of pincushioning, at 5% (n = 2). This result was statistically significant at P = 0.001. This study represents an exploration of techniques to reduce pincushioning and improve aesthetic outcomes in the largest published database of bilobed flaps currently on record. The implications of these findings for operative technique when executing bilobed flap reconstructions are discussed in detail.