Safety Factors Analysis of M-Plasty (Combined Linear and Triangular Advancement Flap) as a Reliable and Effective Skin Minimal Invasive Excisions-Repair Method

Introduction: M-plasty, described by Webster in 1976, is an excision technique in which “M-shaped” incisions are made in surgical wounds. The resulting triangular skin flaps are sutured in slight advancement with the remaining closure. Together with conventional linear repair, they become standard methods in the closure of elliptical excisions. However, In contrast, all surgeons agree conventional closure results in excisions of larger volumes and lengths (66–68.2%)¹ of healthy skin and subcutaneous tissue that may be desirable

Presentation: M-Plasty (M-P) classified as a complex skin repair² born from the conventional schema of ellipse demonstrates significant safety advantage of reducing tension and improves the appearance and healing of wounds. It is commonly used for excisions of skin lesions (benign or malignant). The technique³ involves creating two small opposing triangular advancement flaps that are then sutured with triangulated corner suture and the rest with linear wound closure in continuity achieving less tension and better alignment of the skin edges. Compared with direct linear wound repair, M-P was seen to further augment the following six safety factors of direct wound repair and these are as follows:

1. Simplicity—straightforward and smaller scar.

2. Healing—faster healing with shorter wound length.

3. Reduced risk of complications—decreased exposure and contaminations which predisposed to infection, necrosis, or dehiscence with optimal blood supply and no additional dissection or wound perimeter or undermining.

4. Aesthetics—a significantly smaller linear scar.

5. Tissue preservation.

6. Cost-effectiveness.

M-plasty for direct closure: M-plasty can make direct closure smaller and safer and also in other skin flaps where linear closure is inadequate or not feasible. The safety factors of less tissue undermining, less disruption, less devascularization, less contamination, and less wound perimeter—the risk of wound contamination and complications.

The additional safety factors are as follows:

1. Reduces tension: M-plastyreduces the tension along the wound edges, by creating small triangular flaps with slight advancement at each end achieves a significant, smaller excision area, and enables easier linear closure. Improved vascular supply with its broad-based triangular flaps.

2. Minimizes dog ears: M-plasty helps to minimize these by distributing the tissue more evenly followed by skin tension redistribution.⁴

3. Decreases incision length: removal of same-sized lesion with a clear margin with an overall shorter incision length.⁵

4. Improves cosmetic outcomes: it results in a linear less noticeable scar with a mini-forked feature adapting to contour and often fading into the contracted linear scar with time after wound stretch5 and skin tension redistribution.⁶

5. Special applications: in small-sized⁶ excisions of the face and associated structures and organs (hairlines, eyebrow, eyelid, periorbital and canthus, nose, ears, lips, and ears) head and neck areas.

6. V–Y pattern scar: allows more flexibility and adaptive advantage to regional contour, and when, space is limited and/or free structural margin encroachment

Conclusion: M-plasty (single or double) is a technique with many additional safety features that are highly relevant to patient safety and is appropriate in demanding increased primary consideration in wound repair and educated rethink for further innovative and creative development in the science of skin wound closure.

References

References: References 1-6 on request

Publication History

Article published online:
07 February 2025