Compelling Reconstruction: Double Rotation Subcutaneous Fat Flap for Exposed Tendon Coverage After Mohs Micrographic Surgery of the Pretibial Region

Abstract

Reconstruction of distal pretibial defects remains challenging due to limited tissue laxity and poor vascular support, particularly when tendon is exposed and at risk for desiccation and delayed healing. We present a case of multiply recurrent squamous cell carcinoma of the distal pretibial region treated with Mohs micrographic surgery, resulting in a defect with exposed anterior tibial tendon . A double rotation subcutaneous fat flap was performed using adjacent adipose tissue to provide immediate vascularized coverage. The repair successfully protected the tendon and supported progressive granulation, allowing for uncomplicated healing with preservation of function and contour. This approach highlights a practical and tissue-sparing option for managing complex pretibial defects while promoting a favorable healing environment.