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Page 2 of 10 Schopper et al. Plast Aesthet Res 2022;9:25 https://dx.doi.org/10.20517/2347-9264.2021.72

[1-3]
including distortion of normal structures and strategies to overcome these challenges will be discussed .

Advancement flaps are generally named for the shape of the closed incision including the U-plasty, H-
plasty, T-plasty, V-Y, Y-V, and east-west flap. Variations on advancement flaps include subcutaneous tissue
advancement, island advancement, cervicofacial rotation advancement, Bernard-Burow, and Karapandzic
flaps.

Considerations when planning reconstruction
The reconstructive surgeon must always take into account a few basic principles when considering
approaches to address a defect. These principles include fundamental knowledge of the functional and
aesthetic anatomy of the defect site and proposed donor skin, an understanding of patterns of vascular
supply in the donor tissue, and a recognition of the tension vectors associated with a proposed
reconstruction including primary and secondary movement .
[1]

When analyzing a defect, the surgeon should take into account the specialized issues associated with
reconstructing the complex topography of the face. Care should be taken to avoid distorting structures that
would affect nasal patency, eye closure, or oral competence. Incisions should ideally be designed to hide in
RSTLs or boundaries of aesthetic units for optimal outcomes. Donor tissue should be of adequate laxity to
allow for appropriate primary movement into the defect while accounting for likely secondary movement of
[3,4]
the adjacent tissue .

Reconstructive flaps must have a reliable vascular supply to be successful. In general, flaps can either rely on
a random pattern of unnamed subcutaneous and subdermal plexuses or a larger named artery. Most
advancement flaps are random patterns in nature, relying primarily on anastomoses within the subdermal
plexus. This makes it incumbent upon the surgeon to elevate a flap in the appropriate plane to maintain this
vascular supply. Care should also be taken to consider the proposed flap length when designing a
reconstruction to ensure adequate perfusion pressure at the distal end of the flap and avoid distal necrosis.
Native tissue around the defect site should be of adequate health to allow for neovascularization of the
transposed flap .
[5,6]

UNIPEDICAL FLAPS
U-plasty
The U-plasty is a unipedicle advancement flap, meaning it has a single cutaneous pedicle. The flap is created
by making parallel incisions to free up the donor skin and allow it to slide along the flap’s long axis to fill the
defect. This will result in bilateral standing cone deformities at the base of the flap that may necessitate
excising Burow triangles. Halving sutures could also be used to redistribute redundancy. Care should be
taken to match the shape of the flap’s distal end and the donor site’s distal end. Squaring off flap edges can
limit the risk of a trapdoor deformity. The flap must be completely undermined to allow for free movement.
Likewise, the surrounding skin and soft tissue should be undermined to limit tension and distortion at the
base of the flap [Figure 1].

These flaps are often most useful in areas such as the forehead, where the flap incisions can be designed to
lie in RSTLs or along the brow or hairline. They can also be used in the cheek, where there is abundant
redundancy with care taken to design the axis of movement in a lateral-to-medial vector that minimizes the
[3]
risk of tension on the lower lid or nasofacial sulcus . This type of advancement flap can also be used on the
nose by taking advantage of the redundancy of adjacent tissues. The Rintala flap represents a specialized
form of U-plasty in which skin from the glabella is advanced inferiorly to repair defects of the nasal dorsum.