Bilateral, extended V-Y advancement flap

A modification of the V-Y advancement flap for the closure of circular skin defects is presented to decrease the tension in the closure and to break t he midline vertical scar. Bilateral, extended V-Y advancement flaps with ad ditional limbs extending to the advancing edges of the standard flaps were marked on both sides of the wound. After advancement of the V-Y flaps on th eir subcutaneous pedicle, the upper and lower extensions were hinged downwa rd as transposition flaps to close the middle portion of the circular defec t, where maximum tension occurs. This procedure was applied to 10 patients with sacral and trochanteric pressure sores. No complications or recurrence s were noted during the 2 to 10 months of follow-up, Bilateral, extended V- Y advancement flaps enable the reconstruction of large defects without midl ine tension. Also, the resulting scar where the flaps meet is a zigzag line , so a straight midline scar is avoided.