Common flap methods used for PSD reconstruction are V-Y advancement flap, Limberg flap, Z-plasty, and W-plasty
. [5-7] In the Z-plasty and W-plasty
procedures, a part of the suture line locates in the midline of the wound, and this may cause recurrence.
There have been a few case reports about W-plasty for CMCC, but no large case series presenting results on W-plasty for CMCC has ever been published.
The lesion was closed by using W-plasty or Z-plasty or in a simple linear fashion.
Skin closure was obtained in a simple linear fashion in one patient, with multiple Z-plasty in 2 children and with W-plasty for the rest (18 patients, Figure 3).
One boy of a Mediterranean origin had a small keloid in the scar (following W-plasty) that was managed successfully with 2 injections of 10 mg of triamcinolone acetonide.
Several methods have been proposed for defect closure after excision including a simple vertical closure, Z-plasty, and W-plasty. A simple linear closure can be done if the defect is small , but it might lead to contracture formation and limitation in neck movement, according to Gargan  and Gardner et al.
A better way of dealing with the defect in most cases is to use a single or multiple W-plasty or Z-plasty, especially in case of a large lesion.
Subsequently, a full-thickness skin graft was used to cover the defect, with W-plasty
to prevent web space contracture.
In relation to its surgical treatment, various alternatives have been described including open techniques (open resection), extensive resections (incision and curettage), marsupialization, excision and primary closure, resection and rotation flaps (z-plasty, Limberg technique, Dufourmentel triple L plasty, V-Y plasty, W-plasty
, and modifications of some of these) (Petersen et al., 2002; Bannura, 2003; Al-Khamis et al.; Aydin et al.; Horwood et al.; Enriquez-Navascues et al.; Yabanoglu et al.), and the asymmetric resection (Karydakis technique) (Akinci et al., 2000; Bessa, 2007).
The condition is treated surgically with W-plasty or transverse elliptical incision to excise the hypertrophic mucosa.
The use of W-plasty for the correction of double lip deformity.
The medial scar was surgically excised via a W-plasty