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Causes and Corrections

Frank Custer Koranda, MD; Richard C. Webster, MD

Arch Otolaryngol. 1985;111(7):421-424.

Abstract
• The trapdoor effect is an elevated and bulging deformity of tissue within the semicircular confines of a U-, C-, or Vshaped scar. Various theories to explain this phenomenon are lymphatic and venous obstruction, hypertrophy of the scar, excessive fatty and redundant tissue, beveled wound edges, and contracture of the scar. Our data suggest that scar contracture is the predominant cause of the trapdoor effect in nasolabial flaps. For mild to moderately severe trapdoor deformities, multiple, small Z-plasties about the periphery of the nasolabial flap are indicated. Intralesional triamcinolone acetonide injections may produce a "pharmacologic Z-plasty" effect in some trapdoor deformities. For marked trapdoor deformities, the combination of multiple, small Z-plasties along the semicircular scar and peripheral undermining about the trapdoor defect is the corrective procedure. The trapdoor deformity may be prevented or lessened by peripheral undermining about the recipient site of the flap equal to or greater in area than the recipient site.

(Arch Otolaryngol 1985;111:421-424)

Author Affiliations
From the Department of Otolaryngology—Head and Neck Surgery, University of Kansas Health Sciences Center, Kansas City, Kan (Dr Koranda); the Plastic Surgical Service, Melrose-Wakefield Hospital, Melrose, Mass (Dr Webster); and the Massachusetts Eye and Ear Infirmary, Boston (Dr Webster).

Footnotes
Accepted for publication Dec 12, 1984.

Read before the American Academy of Facial Plastic and Reconstructive Surgery, Las Vegas, Sept 15, 1984.

Reprint requests to Department of Otolaryngology—Head and Neck Surgery, University of Kansas Health Sciences Center, Kansas City, KS 66103 (Dr Koranda).

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