Advancement Flaps in Dermatologic Surgery


A few choices are accessible to the dermatologic specialist for the conclusion of careful deformities. The alternatives extend from the straightforward side-to-side conclusion to more perplexing terminations that utilization skin folds and unites. The decision of conclusion strategy relies upon the patient, the kind of tumor, the area of the injury, and the nearby tissue attributes and accessibility. Signs, procedures, and inconveniences of headway folds are talked about in this article.

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Picking a repair method

The primary issues to address while picking a reconstructive approach are to choose if a skin fold has any favorable circumstances over a side-to-side conclusion and to think about other conclusion choices, for example, optional goal recuperating or skin joining.

The upside of a side-to-side conclusion is that it results in a straight or marginally bent line with little danger of complexities, for example, putrefaction. Auxiliary goal recuperating might be the best choice for sunken territories of the face (eg, conchal bowl, alar depression or edge, melolabial overlay, preauricular territory, average canthus), where it can give a brilliant corrective outcome. Be that as it may, a fold ought to be considered if extreme pressure or anatomical bending is available or if restorative units or loosened up skin strain lines will be broken by a fusiform conclusion. On the off chance that tissue development is lacking for a fold, a join might be required. The best tissue coordinate is frequently gotten with a full-thickness skin unite; nonetheless, ineffectively vascularized territories may just help a split-thickness skin join. Wounds that include uncovered bone, ligament, or ligament or wounds in inadequately vascularized territories that can't bolster unions may require a fold.

The second issues are the area of potential contributor skin and the accessibility of enough tissue. Finding and evaluating benefactor skin can be proficient by tenderly squeezing tissue in various ways around the deformity. Stores of abundance tissue incorporate the glabella, the nasal sidewall, and the average piece of the cheek for nasal deformities; the sanctuary and the glabella for temple surrenders; and the melolabial overlap and the cheek for upper lip absconds.

General standards of tissue development

The following choice is to pick the instrument by which tissue might be moved. Headway, pivot, and transposition folds should all be considered. The impact on encompassing structures must be assessed; specifically, check for any mutilation of free edges. A fundamental learning of the wording of fold elements is basic.

The essential movement will be the development of the fold into the careful or essential deformity. The imperfection made by the fold development makes an optional deformity. The goal of any fold is to close the essential imperfection while limiting the extent of the optional deformity.

Auxiliary movement comprises of the flexible powers endeavoring to return tissue that has been progressed back to its characteristic position. Optional movement incorporates the reaction of the encompassing tissue to the movement of the fold and to the conclusion of the essential and auxiliary deformities. The impacts of these powers are dictated by testing the laxity of the skin under thought by squeezing and extending the tissue before sedative is infused. Undermining the region around the careful deformity may enable better to characterize the powers of strain.

Free edges and anatomical units ought to dependably be assessed for conceivable twisting. Cases of such tests incorporate the snap test on the lower eyelid, which checks for the formation of ectropion. Another test is the use of upward and internal weight on the nasal scaffold (or nose) to decide the potential for rising of the alar edge.

At last, the specialist must decide if tissue can be moved in a way that conceals the last scars. Scar cover is a noteworthy favorable position of folds. Suture lines can be set in facial unit intersection lines or in loosened up skin pressure lines; such arrangement regularly results in scarcely distinguishable scars.

Fold composes

Three kinds of cutaneous folds are utilized: progression, turn, and transposition. The focal point of this article is progression folds. In progression folds, the essential movement is in a straight line from the benefactor site to the essential imperfection, while the auxiliary movement happens the other way. These folds are best utilized in territories of tissue excess.


The essential objective of a progression fold is to exchange the strain of the scar that would result from side-to-side conclusion to an all the more cosmetically satisfactory site. Such destinations incorporate loosened up skin strain lines and the limits between restorative units (eg, melolabial overlay, melolabial wrinkle). Puppy ear remedy scars are uprooted from the first deformity, and they can likewise be covered up in corrective limits or in skin lines.

Mechanics of headway folds

The width of any fold is relative to the width of the imperfection. The pedicle or base of the fold interfaces it to the encompassing tissue. The pedicle contains the fold's vascular supply; in this manner, it is basic to its survival. The area of the pedicle base in connection to the distal part of the fold is regularly used to depict the fold; folds are superior, poorly, medially, or horizontally based.

To guarantee that the pedicle gives satisfactory blood stream, the length-to-width proportion of the fold ought not more often than not surpass 3:1. The thickness of the fold ought to be relative to the profundity of the imperfection, and the fold must contain no less than a thin layer of subdermal fat to incorporate the piece of the vasculature. Diminishing of the distal fold edge to enhance wound shape is normal; be that as it may, diminishing ought to be dodged in patients with a dubious blood supply, for example, those with diabetes or the individuals who smoke.

Longer folds ought to be thicker, particularly at their base, to incorporate the bigger gauge profound subcutaneous vessels expected to sustain the whole length of the fold. Exemptions to this rule are very much vascularized zones, for example, the nasal dorsum or the helix of the ear.

Important Anatomy


Progression folds are not demonstrated for surrenders in which side-to-side conclusion is troublesome and basic bending is likely. The special case is a portable structure, for example, the lip. In this circumstance, a puppy ear can be situated far from the first twisted, making a strain-free conclusion. Shutting the dislodged puppy ear progresses the fold toward the deformity while mitigating strain on the fold and the portable structure. Constraining strain on the imperfection is basic for evading auxiliary mutilation.

Headway folds are proper for tumors extracted with satisfactory edges or by means of Mohs medical procedure, which limits the danger of the repeat. On the off chance that the careful edges are insufficient and the imperfection is repaired with a fold, identifying a repeat might be more troublesome, and reexcision of the repetitive tumor might be broad and distorting.

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