Double helix flap to close a massive circular soft-tissue defect.

The closure of a circular defect resulting from excision of large soft-tissue tumours may pose a considerable surgical challenge. We have described a successful result from the use of modified double helix rotation flaps following resection of a fungating 15-cm interscapular basal cell carcinoma. Our technique necessitated a single operation only. Alternatives considered were split skin grafting, Keystone flap repair or a myocutaneous flap. All modes of repair carry the risk of tension with resultant necrosis and infection. In our case, wound infection did occur, largely due to a heavy pre-operative microbiological burden. This was treated with intra- and postoperative antibiotics and there was no need for subsequent debridement. We propose the double helix flaps as an alternate means to successful local closure of large circular soft-tissue defects.