Advancement flap is

a sliding flap that moves along a single vector directly into the surgical defect

Designed by extending parallel incisions (not necessarily of the same length)

from one side of a surgical defect.

This basic design has also been called a U-plasty or rectangular flap.
The prominent horizontal lines make the advancement flap particularly useful
in the reconstruction of the eyebrow and forehead areas
Figure 4.1 (a) The tissue reservoir is identified
lateral to the surgical wound. (b) Single
rectangular advancement flap design with parallel
incisions drawn within relaxed skin tension lines
and Burows triangles placed at the base of the
flap. The green arrow indicates the primary
motion of the flap. The prominent lines on the
forehead are linear rather than curved and the
circular defect will be squared to allow the
advancing edge of the flap to form perpendicular
lines. (c) Immediate postoperative appearance. (d)
Appearance 6 months after surgery.
The primary advantage of an advancement flap lies in its ability to redistribute standing
cones (dog-ears) to a more favorable location that is not necessarily contiguous with the
defect.

When a circular wound is closed with a linear side-to side closure, standing cones
develop adjacent to the superior and inferior apices. In both rotation and transposition
flaps, a standing cone develops at the pivotal base where it must be excised to allow for
full movement of the flap.

The geometry of an advancement flap allows for excision of tissue redundancy anywhere
along the length of the flap. In this way the incisions can be hidden within relaxed skin
tension lines (RSTLs) or cosmetic unit junction lines

An advancement flap does not lower the tension of closure much beyond that which can
be achieved with a side-to-side closure and it is not a good choice for large defects
without surrounding laxity.

Blood flow to the tip of the flap is inversely related to the tension of wound closure and
even a wide, well-perfused flap is at risk for necrosis if placed under too much strain
Rintala flap
(a) Single rectangular advancement flap design with tissue
reservoir located in the glabella and incision lines along the
cosmetic junction lines of the nasal dorsum. Burows triangles
are placed proximal to the alar grooves within relaxed skin
tension lines and the green arrow indicates the primary
motion of the flap.
(b) Immediate postoperative appearance with temporary
redundancy along the outer skin edges.
(c) Appearance 6 months after surgery

They suggested that the best locations for excision of Burows

triangle are immediately above the eyebrows, at the corner
of the eyes or proximal to the alar grooves. The flap length
should be at least twice the vertical height of the defect and
elevated above the periosteum in the submuscular plane.
(a) Diagram illustrating anticipated
standing cones if side-to-side closure
was performed. (b) Single
rectangular flap design with
enlargement and squaring of the
defect to allow incision lines to
remain within cosmetic junction
lines. (c) Immediate postoperative
appearance with standing cones
redistributed by the rule of halves.
(d) Appearance 2 months after
surgery.
s


Figure 4.13 (a) L-plasty with tissue redundancy excised with the crescentic technique. (b)
Immediate postoperative appearance side view. (c) Immediate postoperative appearance full-
face view. Note that the vertical orientation of the flaps primary movement does not create
tension of the lateral canthus. (d) Appearance 2 months after surgery.
Figure 4.14 (a) Burows triangle flap with Burows triangle excision hidden in the infra-
auricular sulcus. (b) Immediate postoperative appearance. (c) Appearance one week
after surgery.
Figure 4.16 contd, (c) Frontal view one week
postoperative. (d) Lateral view at one week.
Figure 4.18 (a) Cheek advancement flap with M-plasty and second intention healing to preserve the
curve of the alar sulcus. (b) Immediate postoperative appearance. (c) Appearance 2 months after
surgery.
Figure 4.19 (a) Helical rim advancement flap with Burows triangle excised from the lobule. Green arrow indicates
primary movement of the flap. (b) Immediate postoperative appearance. Note exaggerated eversion of the flap
edge with vertical mattress sutures to limit any notching of the helical rim with scar contraction. (c) Appearance 2
months after surgery.
Comparison of the pinch modification of the linear
advancement flap (Peng flap) to the traditional method,
for 1.0-cm
defect. (a, b) Traditional method: flap of 3.0 to 3.5 cm
in length is
needed to cover the 1.0-cm defect. (c) Pinch
modification: flap of
only 1.5 to 1.8 cm is needed to cover the same 1.0-cm
defect
because the flap moves only 0.5 cm

Modified Peng flap. The arms of the flap are

extended
as far down the distal defect as possible. A 30
wedge of tissue
should be removed superior to the wound. Bilateral
Burows triangles
should be excised to facilitate advancement.