Rectangular triple sliding island or 'Pythagorean' flap: dealing with defects from cancerous skin removal

Abstract

The management of extensive skin cancer regions requires full removal of the cancerous area, with the establishment of clear safety borders and successful replacement of the skin defects, with near-healthy skin tissue (skin flap) or combination flaps, necessitated by big defects. Reporting on a real case, a Rectangular Triple Sliding Island (RTSI) or 'Pythagorean' flap procedure was performed, in the side area of the neck of an old aged, and haemorrhagic patient. The procedure involved alternating rotation flaps, in the area with big and extended mobility, in order to facilitate the patient and, for their survival, to provide blood flow to the flap. To our knowledge, this is the first time that the RTSI flap procedure is successfully attempted, with no relative literature existing prior to it. Hopefully, the RTSI flap procedure will be of benefit among skin cancer patients in the future and will even continue to improve as the number of applications increases, granting more experience.