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Schopper et al. Plast Aesthet Res 2022;9:25 https://dx.doi.org/10.20517/2347-9264.2021.72 Page 7 of 10

Figure 6. Cervicofacial advancement flap. (A) Cutaneous post-Mohs defect of the temple and superior cheek measuring approximately
4 cm × 5 cm. (B) Incision premarked out with dashed lines. Incision lines are inconspicuously hidden between important aesthetic
boundaries including hairline, preauricular crease and natural crease of the neck. X and Y markings demonstrate the advancement,
rotation and anticipated attachment of the flap. (C) Following cervicofacial advancement flap closure. This figure is used from senior
[1]
authors’ previous work, Shew et al. . Rights retained.

vermillion lip is then reconstructed with a mucosal advancement flap. The incisions are made only through
the skin and subcutaneous tissue in an effort to preserve sensory function though motor function is not
preserved due to the absence of the orbicularis oris. The resultant shortened, tight lip does help with oral
competency, but pursing of the lips for whistling or kissing is significantly impaired [3,27] [Figure 7].

Karapandzic flap
The Karapandzic flap is a bilateral advancement flap used for closure of large full-thickness defects of the lip
that do not involve the oral commissure. It differs from more simple advancement flaps for lip closure in
that the incisions are not full-thickness in an effort to preserve neurovascular structures. The cutaneous
incision for lower lip defects is designed to parallel to the lip within the mental crease with bilateral limbs
extending around the oral commissure and up into the nasolabial creases to facilitate tissue movement.
Though most often used in the lower lip, the inverse approach can be used for upper lip defects. If
necessary, separate mucosal incisions are made and the intervening tissue is again bluntly dissected to
preserve neurovascular structures. The flaps rotated and advanced to close the lip defect. The Karapandzic
flap preserves the sensory and motor function of the lip but can create microstomia [28-31] [Figure 8].

OTHER CONSIDERATIONS
Solutions for inadequate local tissue - serial advancements, tissue expanders
In some situations, a defect may be situated in such a way that there is insufficient local tissue to perform
the desired repair. While regional flaps, interpolated flaps, and free flaps can all offer solutions in this
setting, local advancement flaps can also be utilized with some modifications. For scar revisions or the
excision of large benign skin lesions, serial excisions and advancements can useful, allowing the native skin
time to stretch and relax between procedures. A similar approach can be used for closure of a fresh defect.
Partial closure is achieved with an advancement flap and the remaining defect is covered with a skin graft
that is later serially excised [3,32,33] .