What are advancement flaps and how are they performed?

There are various methods of repairing skin defects caused by trauma or a skin procedure. One of which is an advancement flap surgery.

Advancement flap is a flap of tissue overextended and sutured in place to conceal an adjacent defect. The three most recognized types are V-Y, monopedicled, and bipedicled.

History of the Procedure

The first person to use an advancement flap in repairing skin defects is Celsus in ancient Rome.

It was made known to the world by French surgeons in the early 1900s. They used to call it, “sliding flaps”.

Nowadays, the use of advancement flaps to cover defects of the scalp, face, and neck is becoming common. These may also be used in anal fissure treatment.

Indications and Contraindications

Advancement flaps are used if the skin defect is near an area of skin laxity. These are also used if the following criteria are met:

• Patient is in good health.
• Skin defect is not infected.
• Defect is free of tumor.

These flaps are contraindicated for patients with poor health like those with bleeding disorders, uncontrolled diabetes mellitus, and chronic smoking history. Additionally, patients with post-surgery tumor surveillance and simultaneous wound infection are not recommended for flap surgery.

How Advancement Flaps are Created

Prior to incision, an advancement flap is first drawn on the skin. This will guide the surgeon during incision.

The surgeon uses a sharp knife to incise the skin. A pair of scissors can also be used to undermine and cut the deep layers of the skin.

The skin defect or lesion is first removed. Incision and undermining of the flap come next. After which, the flap is overstretched towards the other side to cover the skin defect. Then, the edges of the flap are stitched to the skin.

Monopedicled flaps are usually rectangle. They are moved from one side to the other side, which has the defect. A Burow triangle is made at the base of the flap to manage redundant tissue.

Bipedicled flaps are used to close a defect. Unlike monopedicled flaps, bipedicled flaps are moved from both sides of the defect.

Both monopedicled and bipedicled flaps are applicable for the forehead and the lips.

In V-Y flaps, a V-shaped incision is first made. This turns into a shape of Y at the end of procedure.

The advantage of V-Y flaps include prevention of pincushioning edema and   preservation of subcutaneous circulation.

What to Expect after Surgery

Usually, patients are asked to visit their surgeon a week after the surgery for the removal of sutures.

A pincushioning scar may result after the surgery. This may be treated with a small amount of subdermal triamcinolone injection.

As for scar widening, treatments may include additional undermining, scar excision, and careful closure.

Scar dermabrasion may also be performed six weeks or more after surgery. A wavelength laser may also be offered to a patient if scar erythema is persistent within eight to twelve weeks.

Advancement flaps are preferred since the skin to be moved matches the thickness, texture, and color of the adjacent area. Post-surgical scars are also more favorable.