“…Due to these disadvantages (see above) various alternative closed surgical techniques with primary wound closure are available. Surgical techniques with primary wound closure in the midline or asymmetric excisions with horizontal wound closure result in up to 20 % in postoperative wound healing disturbances and infections, e. g. due to the resulting tension [4]. Lack of tension, flattening of the rima ani and sufficient perifocal soft tissue mobilization can in the end effect only be achieved by an asymmetric transposition flap.…”