"Pac man" flap for closure of pressure sores

The purpose of this study was to modify the classic bilateral V-Y advanceme nt flap procedure to decrease the tension in its closure and to break the m idline vertical scar by interdigitating the flaps. After debridement of a p ressure sore, the V-Y flaps were marked on both sides of the wound. Skin in cisions were carried down to the muscle fascia along the sides of the flaps . The upper and lower limbs of the V-shaped flaps were elevated as triangul ar flaps but remained attached to the main flap. The tip of the upper limb of one of the flaps was transposed into the defect and sutured to the contr alateral V-Y flap at the midpoint of its concave side facing the defect. Th e lower limb of the contralateral flap was then transposed into the defect and sutured to the first V-Y flap. To complete the interdigitated closure, the lower limb of the first flap was sutured below the contralateral flap, and the upper limb of the contralateral flap was sutured above the first fl ap. The final view of the flaps was similar to "Pac Man," so the authors de cided to call this flap the Pac Man flap. The flaps healed well in all pati ents, and wound breakdown or recurrence of the pressure sore was not observ ed during the 3 to 14-month follow-up.