Advancement Flaps

Excerpt

When conventional wound closure methods, whether for cosmetic or functional reasons, prove impractical, the need arises for additional tissue reconstruction. This necessitates the use of grafts or flaps. Grafts, like split-thickness skin or mucosal grafts, serve as non-vascularized tissue patches. In contrast, flaps are vascularized, contributing to high success rates in healing. Flaps can originate from distant body sites, requiring microsurgical blood vessel anastomosis near the wound site, earning them the label microvascular "free" flaps. "Regional" flaps involve tissue transfer from non-adjacent areas without such microsurgical connections, while "local" flaps move tissue immediately neighboring the primary defect. Local flaps are further classified into transposition, rotation, advancement, and interpolation, with the latter sometimes categorized as a hallmark of regional flaps by different authors. Advancement flaps are conceptually the simplest local flaps and, along with rotation flaps, are sometimes known as "sliding" flaps. For sliding flaps, the tissue is moved or "slid" directly into the adjacent defect without crossing over or under normal tissue, as is seen in transposition and interpolated flaps.

Local flap advancement is a versatile cornerstone in cutaneous surgery for several compelling reasons. Firstly, these flaps boast a straightforward conceptual framework, demanding far less spatial reasoning or geometric finesse in their design compared to transposition flaps like z-plasties and bilobed flaps. Secondly, they possess the distinct advantage of not leaving secondary defects that necessitate subsequent closure at the flap's initial elevation or harvesting site, a challenge common to transposition, interpolated, regional, and free flaps. Moreover, tissue advancement techniques find utility beyond wound closure scenarios. For instance, V to Y advancement aids in lengthening the columella of the nose in cleft lip cases, restoring the position of the lobule in post-rhytidectomy pixie ear deformities, correcting partial syndactyly, and releasing scar bands that distort anatomical structures such as the eyelid. Furthermore, these techniques extend their utility to cosmetic or gender-affirming procedures like lowering the hairline with scalp advancement and forming the basis of facelift surgery through cheek advancement.