Modified bilateral advancement flap: The slide-in flap

The bilateral V-Y advancement flaps are used commonly in the closure of cir cular skin defects. We modified the standard bilateral V-Y advancement flap technique to reduce the tension along the closure, and used it in 10 patie nts between 1995 and 1997. In the presence of a circular defect, bilateral V-Y advancement flaps were marked on the skin, with the height of the V fla ps measuring 1.5 to 2 times the diameter of the defect, The limbs of the V were not drawn as straight lines, but were curved outward slightly, making the flap and its two extensions broader than the standard V-Y flap. The bro ad extensions of the V flaps encircled the defect from above and below. Ski n incisions were made vertically down to the muscle fascia. Additional unde rmining was carried out to elevate the upper and lower extensions of the V flaps for a distance that equaled the radius of the defect. The upper and l ower extensions of the V flap on one side were transposed into the defect a nd sutured to the concave base of the apposing flap V flap at its midpoint. These extensions were then sutured to each other. The extensions of the op posing V flap were then transposed into the defect; the upper being superio r and the lower being inferior to the extensions of the first flap. The res t of the operation was completed by advancement of the V flaps and closure in a Y configuration. The efficient redistribution of available tissue by t he combined use of transposition and advancement principles resulted in the repair of relatively large skin defects with reduced tension along the clo sure. Satisfactory results were obtained in all patients in this series wit hout any surgical complication.