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Schopper et al. Plast Aesthet Res 2022;9:25 Plastic and
DOI: 10.20517/2347-9264.2021.72
Aesthetic Research

Review Open Access

Advancement flaps

Heather Schopper, J. David Kriet, Clinton Humphrey
Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS 66160, USA.
Correspondence to: Dr. Clinton Humphrey, Department of Otolaryngology - Head and Neck Surgery, University of Kansas
Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA. E-mail: chumphrey@kumc.edu

How to cite this article: Schopper H, Kriet JD, Humphrey C. Advancement flaps. Plast Aesthet Res 2022;9:25.
https://dx.doi.org/10.20517/2347-9264.2021.72

Received: 21 Jun 2021 First Decision: 9 Oct 2021 Revised: 23 Oct 2021 Accepted: 23 Feb 2022 Published: 9 Apr 2022

Academic Editor: Wen-Guo Cui Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Local advancement flaps are a key tool in the armamentarium of the reconstructive surgeon. They can be used to
repair small and large defects on all areas of the face with excellent skin color and texture match, limited donor site
morbidity, and flexibility to hide scars. In this review, we outline common categories of advancement flaps and
discuss common situations for their use.
Keywords: Advancement flaps, local reconstruction, facial cutaneous defects

INTRODUCTION
Local advancement flaps are a useful tool for reconstructing facial skin defects. While many forms of local
tissue reconstruction incorporate an element of advancement, advancement flaps are technically
characterized by sliding or stretching the flap skin along a single vector. This type of flap therefore relies on
the elasticity of the skin and/or skin redundancy to facilitate closure of the defect. Care must be taken to
orient the limbs of the flap parallel to relaxed skin tension lines (RSTLs) to avoid creating an aesthetically
obvious scar. Most advancement flaps are random pattern flaps, relying on the unnamed cutaneous
vasculature to supply the tissue. Traditionally, a length to width ratio of no more than 3:1 is recommended,
though there is no clear evidence to support this. The area of greatest tension in the closure is at the distal
flap edge. Advancement flaps offer a number of benefits including excellent skin color and texture match,
limited donor site morbidity, and flexibility to hide scars. Reconstructing larger defects poses challenges

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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