Coverage of Defects

10.1055/b-0034-99026

Coverage of Defects

Local Flaps

Local flaps are flaps that are raised from tissues in the immediate vicinity of the defect.

Advancement Flaps

Advancement Flap of Burow (1855)

Simple triangular defects can be covered by advancing the adjacent skin. A small Burow’s triangle is excised at the opposite end of the flap ( Fig. 3.1a ) to prevent formation of a dog ear.

Burow’s U-Advancement

( Figs. 3.2–3.7 )

The U-shaped skin advancement requires the excision of two Burow’s triangles ( Fig. 3.2a ). The length-to-width ratio of the standard U-flap should not exceed 2:1, and a 3:1 ratio is allowed only in exceptional cases.

In the Stark modification of the U-advancement (quoted in Jost et al. 1977), the flap is widened toward its base. Cut-backs can be added to increase the flap length ( Fig. 3.3a ). The extra small defects created by the flap are closed by mobilizing the surrounding skin ( Fig. 3.3b ). Other modifications are shown in Figs. 3.4–3.7 .

**a, b** **Advancement flap** of Burow (1855). a The flap is incised along the base of the wedge-shaped defect, and a small Burow’s triangle (arrow) is excised on the opposite side. The skin is mobilized and shifted in the direction of the arrow to close the defect. Excising the small Burow’s triangle eliminates a dog ear at the base of the flap. b Appearance after coverage of the defect (see **Figs. 5.1** and **5.24** ).

**a, b** **U-advancement** of Burow. a The ratio of defect (D) length to flap length is ~1:2, and the base-to-length ratio of the flap should not exceed 1:2. The flap is advanced by excising two small Burow’s triangles and mobilizing the surrounding skin. b Closure of all defects (see **Figs. 5.14, 5.26, 10.17** ).

**a, b** **Modifications of defect closure using Burow’s triangles.**

V-Y and V-Y-S Advancement of Argamaso (1974)

( Figs. 3.8–3.10 )

The V-Y advancement and double V-Y-S advancement of Argamaso (1974) are special designs used for releasing contracted scars, for columellar reconstruction from the upper lip, and for lengthening the frenulum ( Fig. 3.8 ).

**a–c** **V-Y advancement** (see **Fig. 5.4** ). a A contracted scar or the frenulum can be lengthened by making a V-shaped incision, mobilizing the flap, and advancing it in the direction of the arrow. b The skin is mobilized. c Closure of the defects.

**a–c** **Modification of the V-Y plasty** (see **Figs. 5.2** and **5.10** ).

**a, b** **V-Y-S advancement** of Argamaso (1974).

Flaps without Continuous Epithelial Coverage (Rettinger 1996a, b)

Sliding Flap

( Figs. 3.11–3.14 )

Another interesting type of advancement flap is the sliding flap, which is based entirely on subcutaneous tissue. Barron and Emmett (1965) devised a flap with a lateral subcutaneous pedicle ( Fig. 3.11 ; see also Figs. 5.33, 5.44, 6.16 ). The skin flap is outlined, and the pedicle is mobilized on one side. The flap is slid into the defect on the subcutaneous pedicle. Lejour (1975) described a similar flap based on subcutaneous tissue ( Figs. 3.12–3.14 ; see also Fig. 5.7 ). We have used this type of flap to repair defects in the tongue (Weerda 1985; Fig. 3.14 ).