Advancement Flaps

  • Michael C. Cameron
  • Mariah R. BrownEmail author


Local tissue flaps are single-stage procedures that take advantage of adjacent tissue reservoirs for tissue replacement in order to reconstruct cutaneous surgery defects. In dermatologic surgery, local flaps are commonly performed after removal of benign or malignant skin lesions, particularly surgical defects created by Mohs micrographic surgery to treat skin cancer. Other indications include scar revision, correction of congenital abnormalities, and reconstruction after trauma. Advancement flaps are local flaps that utilize the linear movement of incised tissue in a single direction for closure of a tissue defect. Advancement flaps can be used to close a variety of defects in different anatomic sites but are most commonly used in dermatologic surgery for surgical defects on the head and neck. This chapter will review the existing evidence for various advancement flaps and its various for different indications in the field of procedural dermatology.


Advancement flaps Procedural dermatology Skin cancer Reconstruction 


  1. 1.
    Gillies HD, Millard DR. The principles and art of plastic surgery. 1st ed. Boston: Little; 1957.Google Scholar
  2. 2.
    Donaldson MR, Coldiron BM. Dermatologists perform the majority of cutaneous reconstructions in the Medicare population: numbers and trends from 2004 to 2009. J Am Acad Dermatol. 2013;68(5):803–8.PubMedGoogle Scholar
  3. 3.
    Alam M, Ibrahim O, Nodzenski M, et al. Adverse events associated with Mohs micrographic surgery: multicenter prospective cohort study of 20,821 cases at 23 centers. JAMA Dermatol. 2013;149(12):1378–85.PubMedGoogle Scholar
  4. 4.
    Chen DL, Carlson EO, Fathi R, Brown MR. Undermining and hemostasis. Dermatol Surg. 2015;41(Suppl 10):S201–15.PubMedGoogle Scholar
  5. 5.
    Alam M, Goldberg LH. Serious adverse vascular events associated with perioperative interruption of antiplatelet and anticoagulant therapy. Dermatol Surg. 2002;28(11):992–8; discussion 998.PubMedGoogle Scholar
  6. 6.
    Bordeaux JS, Martires KJ, Goldberg D, Pattee SF, Fu P, Maloney ME. Prospective evaluation of dermatologic surgery complications including patients on multiple antiplatelet and anticoagulant medications. J Am Acad Dermatol. 2011;65(3):576–83.PubMedGoogle Scholar
  7. 7.
    Goldberg LH, Mauldin DV, Humphreys TR. The postauricular cutaneous advancement flap for repairing ear rim defects. Dermatol Surg. 1996;22(1):28–31.PubMedGoogle Scholar
  8. 8.
    Field LM. The single-pedicle retroauricular advancement flap. J Dermatol Surg Oncol. 1988;14(7):722–7.PubMedGoogle Scholar
  9. 9.
    Antia NH, Buch VI. Chondrocutaneous advancement flap for the marginal defect of the ear. Plast Reconstr Surg. 1967;39(5):472–7.PubMedGoogle Scholar
  10. 10.
    Varas-Meis E, Perez-Paredes MG, Rodríguez-Prieto MÁ. Superior Antia-Buch flap for reconstruction of helical rim defects. J Am Acad Dermatol. 2016;74(4):e67–8.PubMedGoogle Scholar
  11. 11.
    Fangman WL, Stoer CB. Reconstruction of a helical rim defect. Dermatol Surg. 2010;36(2):245–9.PubMedGoogle Scholar
  12. 12.
    Ramsey ML, Marks VJ, Klingensmith MR. The chondrocutaneous helical rim advancement flap of Antia and Buch. Dermatol Surg. 1995;21(11):970–4.PubMedGoogle Scholar
  13. 13.
    de Schipper HJ, van Rappard JH, Dumont EA. Modified Antia Buch repair for full-thickness middle auricular defect. Dermatol Surg. 2012;38(1):124–7.PubMedGoogle Scholar
  14. 14.
    Butler CE. Reconstruction of marginal ear defects with modified chondrocutaneous helical rim advancement flaps. Plast Reconstr Surg. 2003;111(6):2009–13.PubMedGoogle Scholar
  15. 15.
    Zilinsky I, Cotofana S, Hammer N, et al. The arterial blood supply of the helical rim and the earlobe-based advancement flap (ELBAF): a new strategy for reconstructions of helical rim defects. J Plast Reconstr Aesthet Surg JPRAS. 2015;68(1):56–62.PubMedGoogle Scholar
  16. 16.
    Humphreys TR, Goldberg LH, Wiemer DR. The postauricular (revolving door) island pedicle flap revisited. Dermatol Surg. 1996;22(2):148–50.PubMedGoogle Scholar
  17. 17.
    Patterson AR, Brady G, Walker PD, Telfer MR. The perichondrial cutaneous graft and “flip-flop” flap in facial reconstruction: a series of 41 cases. Br J Oral Maxillofac Surg. 2008;46(2):114–8.PubMedGoogle Scholar
  18. 18.
    Carroll BT, Gillen WS, Maher IA. Transpositional modification of the posterior auricular pull-through flap: a new twist. Dermatol Surg. 2014;40(1):79–82.PubMedGoogle Scholar
  19. 19.
    Fader DJ, Johnson TM. Ear reconstruction utilizing the subcutaneous island pedicle graft (flip-flop) flap. Dermatol Surg. 1999;25(2):94–6.PubMedGoogle Scholar
  20. 20.
    Cordova A, Pirrello R, D'Arpa S, Moschella F. Superior pedicle retroauricular island flap for ear and temporal region reconstruction: anatomic investigation and 52 cases series. Ann Plast Surg. 2008;60(6):652–7.PubMedGoogle Scholar
  21. 21.
    Lambert RW, Dzubow LM. A dorsal nasal advancement flap for off-midline defects. J Am Acad Dermatol. 2004;50(3):380–3.PubMedGoogle Scholar
  22. 22.
    Geist DE, Maloney ME. The “east-west” advancement flap for nasal defects: reexamined and extended. Dermatol Surg. 2012;38(9):1529–34.PubMedGoogle Scholar
  23. 23.
    Goldberg LH, Alam M. Horizontal advancement flap for symmetric reconstruction of small to medium-sized cutaneous defects of the lateral nasal supratip. J Am Acad Dermatol. 2003;49(4):685–9.PubMedGoogle Scholar
  24. 24.
    Hussain W, Tan E, Salmon PJ. Inferiorly based crescentic “sliding” cheek flaps for the reconstruction of paranasal surgical defects. Dermatol Surg. 2012;38(2):249–55.PubMedGoogle Scholar
  25. 25.
    Hill TG. The perialar arc rotation skin flap. J Dermatol Surg Oncol. 1989;15(1):78–83.PubMedGoogle Scholar
  26. 26.
    Mellette JR Jr, Harrington AC. Applications of the crescentic advancement flap. J Dermatol Surg Oncol. 1991;17(5):447–54.PubMedGoogle Scholar
  27. 27.
    Yoo SS, Miller SJ. The crescentic advancement flap revisited. Dermatol Surg. 2003;29(8):856–8.PubMedGoogle Scholar
  28. 28.
    Borchard KL, Gunson TH, Smith HR, Vinciullo C. Pushing the perialar: a modified perialar crescentic advancement flap for the reconstruction of large nasal sidewall defects. Dermatol Surg. 2013;39(6):956–9.PubMedGoogle Scholar
  29. 29.
    Zeikus P, MacCormack M, Olbricht S. Dog ear island pedicle flap for repair of alar and nasal wall defects. Dermatol Surg. 2008;34(12):1697–700.PubMedGoogle Scholar
  30. 30.
    Zeikus PS, Maloney ME, Jellinek NJ. Advancement flap for the reconstruction of nasal ala and lateral nasal tip defects. J Am Acad Dermatol. 2006;55(6):1032–5.PubMedGoogle Scholar
  31. 31.
    Onishi K, Okada E, Hirata A. The Rintala flap: a versatile procedure for nasal reconstruction. Am J Otolaryngol. 2014;35(5):577–81.PubMedGoogle Scholar
  32. 32.
    Maruyama Y, Iwahira Y. The axial nasodorsum flap. Plast Reconstr Surg. 1997;99(7):1873–7.PubMedGoogle Scholar
  33. 33.
    Love WE, Sweeney SM, Maloney ME, Bordeaux JS. Columellar advancement flap for midline nasal defects. Dermatol Surg. 2010;36(2):241–4.PubMedGoogle Scholar
  34. 34.
    Rybka FJ. Reconstruction of the nasal tip using nasalis myocutaneous sliding flaps. Plast Reconstr Surg. 1983;71(1):40–4.PubMedGoogle Scholar
  35. 35.
    Constantine VS. Nasalis myocutaneous sliding flap: repair of nasal supratip defects. J Dermatol Surg Oncol. 1991;17(5):439–44.PubMedGoogle Scholar
  36. 36.
    Wee SS, Hruza GJ, Mustoe TA. Refinements of nasalis myocutaneous flap. Ann Plast Surg. 1990;25(4):271–8.PubMedGoogle Scholar
  37. 37.
    Papadopoulos DJ, Trinei FA. Superiorly based nasalis myocutaneous island pedicle flap with bilevel undermining for nasal tip and supratip reconstruction. Dermatol Surg. 1999;25(7):530–6.PubMedGoogle Scholar
  38. 38.
    Willey A, Papadopoulos DJ, Swanson NA, Lee KK. Modified single-sling myocutaneous island pedicle flap: series of 61 reconstructions. Dermatol Surg. 2008;34(11):1527–35.PubMedGoogle Scholar
  39. 39.
    Papadopoulos DJ, Pharis DB, Munavalli GS, Trinei F, Hantzakos AG. Nasalis myocutaneous island pedicle flap with bilevel undermining for repair of lateral nasal defects. Dermatol Surg. 2002;28(2):190–4.PubMedGoogle Scholar
  40. 40.
    Krathen RA, Meunnich E, Donnelly HB. Island pedicle flap for alar defects. Dermatol Surg. 2010;36(3):386–91.PubMedGoogle Scholar
  41. 41.
    Asgari M, Odland P. Nasalis island pedicle flap in nasal ala reconstruction. Dermatol Surg. 2005;31(4):448–52.PubMedGoogle Scholar
  42. 42.
    Rohrer TE, Migden MR. Flaps and grafts in dermatologic surgery. Philadelphia: Elsevier Saunders; 2007. Scholar
  43. 43.
    Carvalho LM, Ramos RR, Santos ID, Brunstein F, Lima AH, Ferreira LM. V-Y advancement flap for the reconstruction of partial and full thickness defects of the upper lip. Scand J Plast Reconstr Surg Hand Surg. 2002;36(1):28–33.PubMedGoogle Scholar
  44. 44.
    Griffin GR, Weber S, Baker SR. Outcomes following V-Y advancement flap reconstruction of large upper lip defects. Arch Facial Plast Surg. 2012;14(3):193–7.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Huilgol SC, Ma JHY, Hills RJ. Double island pedicle or V-Y flap repair for partial-thickness combined defects of the cutaneous and mucosal lip. J Am Acad Dermatol. 2014;71(6):1198–203.PubMedGoogle Scholar
  46. 46.
    Paniker PU, Mellette JR. A simple technique for repair of Cupid’s bow. Dermatol Surg. 2003;29(6):636–40.PubMedGoogle Scholar
  47. 47.
    Kaufman AJ, Grekin RC. Repair of central upper lip (philtral) surgical defects with island pedicle flaps. Dermatol Surg. 1996;22(12):1003–7.PubMedGoogle Scholar
  48. 48.
    Sand M, Altmeyer P, Bechara FG. Mucosal advancement flap versus primary closure after vermilionectomy of the lower lip. Dermatol Surg. 2010;36(12):1987–92.PubMedGoogle Scholar
  49. 49.
    Onishi K, Maruyama Y, Hayashi A, Inami K. Repair of scalp defect using a superficial temporal fascia pedicle VY advancement scalp flap. Br J Plast Surg. 2005;58(5):676–80.PubMedGoogle Scholar
  50. 50.
    Ibrahimi OA, Jih MH, Aluma-Tenorio MS, Goldberg LH, Kimyai-Asadi A. Repair of scalp defects using an H-plasty type of bilateral advancement flap. Dermatol Surg. 2010;36(12):1993–7.PubMedGoogle Scholar
  51. 51.
    Birgfeld CB, Chang B. The periglabellar flap for closure of central forehead defects. Plast Reconstr Surg. 2007;120(1):130–3.PubMedGoogle Scholar
  52. 52.
    Ransom ER, Jacono AA. Double-opposing rotation-advancement flaps for closure of forehead defects. Arch Facial Plast Surg. 2012;14(5):342–5.PubMedGoogle Scholar
  53. 53.
    Gardner ES, Goldberg LH. Eyebrow reconstruction with the subcutaneous island pedicle flap. Dermatol Surg. 2002;28(10):921–5.PubMedGoogle Scholar
  54. 54.
    Boggio P, Gattoni M, Zanetta R, Leigheb G. Burow’s triangle advancement flaps for excision of two closely approximated skin lesions. Dermatol Surg. 1999;25(8):622–5.PubMedGoogle Scholar
  55. 55.
    LeVasseur JG, Mellette JR. Applications of the double O to Z flap repair for facial reconstruction. Dermatol Surg. 2001;27(1):79–81.PubMedGoogle Scholar
  56. 56.
    Sugg KB, Cederna PS, Brown DL. The V-Y advancement flap is equivalent to the Mustarde flap for ectropion prevention in the reconstruction of moderate-size lid-cheek junction defects. Plast Reconstr Surg. 2013;131(1):28e–36e.PubMedPubMedCentralGoogle Scholar
  57. 57.
    Skaria AM. Island pedicle flaps for medial canthus repair. Br J Dermatol. 2012;166(6):1270–4.PubMedGoogle Scholar
  58. 58.
    Cecchi R, Fancelli L, Troiano M. Island flaps in the repair of medial canthus: report of 8 cases. Dermatol Online J. 2013;19(6):18576.PubMedGoogle Scholar
  59. 59.
    Bennett RG. Local skin flaps on the cheeks. J Dermatol Surg Oncol. 1991;17(2):161–5.PubMedGoogle Scholar
  60. 60.
    Raklyar E, Zloty DM. Use of a patient and observer scar assessment scale to evaluate the V-Y advancement flap for reconstruction of medial cheek defects. Dermatol Surg. 2012;38(12):1968–74.PubMedGoogle Scholar
  61. 61.
    Yildirim S, Akoz T, Akan M, Avci G. Nasolabial V-Y advancement for closure of the midface defects. Dermatol Surg. 2001;27(7):656–8; discussion 658–660.PubMedGoogle Scholar
  62. 62.
    Coombs CJ, Ng S, Stewart DA. The use of V-Y advancement flaps for closure of pretibial skin defects after excision of cutaneous lesions. Ann Plast Surg. 2013;71(4):402–5.PubMedGoogle Scholar
  63. 63.
    Dini M, Innocenti A, Russo GL, Agostini V. The use of the V-Y fasciocutaneous island advancement flap in reconstructing postsurgical defects of the leg. Dermatol Surg. 2001;27(1):44–6.PubMedGoogle Scholar
  64. 64.
    Venkataramakrishnan V, Mohan D, Villafane O. Perforator based V-Y advancement flaps in the leg. Br J Plast Surg. 1998;51(6):431–5.PubMedGoogle Scholar
  65. 65.
    Niranjan NS, Price RD, Govilkar P. Fascial feeder and perforator-based V-Y advancement flaps in the reconstruction of lower limb defects. Br J Plast Surg. 2000;53(8):679–89.PubMedGoogle Scholar
  66. 66.
    Magliano J, Falco S, Agorio C, Bazzano C. Modified keystone flap for extremity defects after Mohs surgery. Int J Dermatol. 2016;55:1391.PubMedGoogle Scholar
  67. 67.
    Martinez JC, Cook JL, Otley C. The keystone fasciocutaneous flap in the reconstruction of lower extremity wounds. Dermatol Surg. 2012;38(3):484–9.PubMedGoogle Scholar
  68. 68.
    Behan FC. The keystone design perforator island flap in reconstructive surgery. ANZ J Surg. 2003;73(3):112–20.PubMedGoogle Scholar
  69. 69.
    Stone JP, Webb C, McKinnon JG, Dawes JC, McKenzie CD, Temple-Oberle CF. Avoiding skin grafts: the keystone flap in cutaneous defects. Plast Reconstr Surg. 2015;136(2):404–8.PubMedGoogle Scholar
  70. 70.
    Elliott TG, Thom GA, Litterick KA. Office based dermatological surgery and Mohs surgery: a prospective audit of surgical procedures and complications in a procedural dermatology practice. Australas J Dermatol. 2012;53(4):264–71.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.University of Colorado School of Medicine, Department of DermatologyAuroraUSA

Personalised recommendations