After complete skin cancer excision with clear margins, skin defects must be reconstructed using nearby healthy tissue. Building on seven previously published flap techniques, this paper introduces nine additional rectangular flap procedures in three categories - Island ('Hippodamian'), Rotation, and Divided - designed for use in non-elastic, anatomically restricted areas. Island flaps follow straight or 90-degree axes in regions with low mobility or curved surfaces. Divided flaps suit stiff, confined areas such as the inner ear or fingers, where multidirectional tension demands added elasticity. Rotation flaps may incorporate a triple 90-degree back cut to enhance mobility, reduce suturing tension, and avoid necrosis by replacing narrow tips with broad 90-degree corners. These new methods minimise the need for extended incisions and reduce bleeding - particularly important in older patients on anticoagulants - thereby lowering risks of hematoma and poor healing. They expand reconstructive options, enabling more tailored solutions for patients, especially the elderly.
George N. Sgouros (2025) studied this question.