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Schopper et al. Plast Aesthet Res 2022;9:25 https://dx.doi.org/10.20517/2347-9264.2021.72 Page 3 of 10

Figure 1. U-plasty. (A) Two parallel incisions are made to allow for movement in a linear vector. Burow triangles may need to be excised
to correct standing cone deformities. (B) Closure following advancement. This figure is used from senior authors’ previous work,
[1]
Shew et al. . Rights retained.

Burow triangles are excised from the base of the flap to avoid distortion of the medial brow . The lateral
[7]
nasal advancement flap advances skin from the medial cheek onto the nasal sidewall or dorsum. Burow
triangles can be well hidden within the nasofacial sulcus and alar groove .
[8]

H-plasty
The H-Plasty is a bilateral modification of the unipedicle flap, which can be useful in closing larger defects
where there is insufficient tissue or laxity unilaterally to fully close the defect. The limbs need not be the
same length and can be customized to fit the character of the adjacent tissue. It is recommended to raise
only one flap at a time as often more advancement than anticipated can be generated from a single flap. Like
the U-plasty, standing cone deformities may be generated that can be dealt with by excising Burow triangles
at the bases of the pedicles or at the defect to effectively shrink the defect. The H-plasty is useful for the
forehead for the same reasons as the U-plasty and can also be helpful for reconstructing defects of the
central lip and chin [Figure 2].
[2,9]
T-plasty
The T-plasty, like the H-plasty, is a bilateral unipedical flap that utilizes a single incision on each side of the
defect to free up the skin to advance. The T-plasty may also be called an A-T or O-T, referencing the
triangular or round shape of the original defect respectively. Sometimes a round defect may be made
fusiform by superiorly excising a cone of tissue. The advancement of the flaps does create a standing cone
deformity which is addressed by excising a Burow triangle when necessary. Like the H-plasty, the T-plasty
requires smaller flaps to close the defect than a U-plasty which may be advantageous in areas with less
available donor skin. Its single horizontal incision may offer a better aesthetic result than the H-plasty. The
flap may be useful for forehead defects with the horizontal incision hidden in the brow or hairline or the lip
with the horizontal limb oriented parallel to the vermillion border as seen in Figure 3. It is important to be
mindful of scar contracture of the vertical limb when used for lip repairs, as this may result in distortion of
the vermilion border [3,10] .