The “Reading Man” Procedure

Background: As most of the skin lesions tend to grow in a circular pattern, the resultant defects after surgical removal of these lesions are often circular. Although a number of local flap procedures have been described, alternative techniques are still needed for the closure of circular defects. Purpose: Here, a new surgical technique for the closure of circular skin defects is presented. This technique basically uses the extra skin relaxation gained with an unequal Z-plasty maneuver in favor of the defect closure. The procedure is named as "the reading man" because its surgical design resembles the silhouette of a man who is reading a book held in his hand. Material and Methods: In this technique, 2 flaps designed in an unequal Z-plasty manner are used. The first flap is transposed to the defect area whereas the second flap is used for closure of the first flap's donor site. For 3 years, this technique has been used for closure of the circular skin defects in 27 patients (19 men and 8 women) aged from 2 months to 68 years. The defect size was ranging between 1.5 and 14 cm in diameter. Results: A tension-free defect closure was obtained in all patients. All flaps healed with no complications. There was no patient with dog ear formation. A mean follow-up of 15 months (6 months–3 years) revealed an esthetically acceptable scar formation in all patients. Conclusion: The reading man procedure was found to be a useful and an easy going technique for the closure of circular skin defects located on various anatomic regions. It enables surgeon to obtain a tension-free closure of considerably large skin defects with minimal scarring and additional healthy skin excision.