First described by Caminer et al, the crown flap is a modified keystone flap. The curvilinear shaped trapezoidal design of the latter positions the point of maximum tension at the central aspect of the defect ellipse. The crown flap consists of three V-Y advancement flaps, the third V-Y is incorporated centrally to reduce tension at the tightest aspect of the repair.
A prospective series of crown flap reconstructions over a 24 month period is presented. Patient demographics, co-morbidities, indications, defect dimensions and post-operative complications were recorded. All flaps were inset using a combination of dermal and skin sutures. Oral antibiotics were administered for seven days post-operatively. Patients with flap reconstructions on the lower limb were instructed to remain on bed rest for two days post-operatively and to maintain a non-weight bearing status for a further five days.
The mean age was 71 years (range 57-83 years). 80% of patients were female and 20% were male. Indications for reconstruction included defects post excision of BCCs, SCCs and wider excision of malignant melanomas that were not amenable to primary closure. 80% of defects were located on the lower limbs and 20% were located on the uper limbs. The mean defect lengths and widths were 66mm and 24mm respectively (ranges 52-76mm and 20-28mm). No major complications were recorded. One patient developed a wound infection, which was treated with oral antibiotics.
The addition of the third V-Y flap provides more mobility to close the central defect in crown flap reconstructions and further utilises the surrounding tissue laxity to close the donor site.
The crown flap is a versatile reconstructive option that can be used on any area of the body where V-Y advancement closures are usually performed. The cosmetic results were rated as very good to excellent in the series presented.