The closure of some lower extremity surgical defects may challenge the dermatologic surgeon. This is especially the case with older patients who have severely atrophic, friable skin that makes suture placement difficult if there is any wound tension.
We describe the bilateral subcutaneous island pedicle flap as a suitable closure technique for lower extremity defects when primary linear or layered closure is not an option. In our case report, 2 triangular flaps on opposite sides of the defect were incised down to the subcutaneous tissue, advanced into the surgical defect, and sutured into place with buried subcutaneous sutures.
This repair is an excellent consideration for thin skin resembling tissue paper in which minimal wound tension is necessary for sutures to hold properly. The bilateral subcutaneous island pedicle flap is a versatile, effective means of repairing many lower extremity defects when primary linear or layered closure is not an option.