The Modified Bilateral Advancement Flap

BACKGROUND: Bilateral advancement flaps are commonly used in the closure of circular skin defects because of their ease of execution and satisfactory result. However, the limited sliding capacity of these flaps has always been a problem. OBJECTIVE: The modified bilateral advancement flap maximizes the amount of tissue that can be brought into the defect. It relies on both advancement and transposition principles and borrows tissue from two planes. Thus the length of the flap could be shortened for increased flap survival. METHODS: Bilateral transposition flaps are created from tissue on both sides of the wound. These are then approximated and sutured together to form a single, new tip (apex), which is then advanced and sutured into the concave base of the opposing advancement flap at its midpoint. RESULTS: The modified bilateral advancement flap has been used effectively to close defects in the temporal, cheek, forehead, and lower eyelid, among 11 patients, providing a well-contoured and aesthetically pleasing reconstruction. CONCLUSION: This method extends the capacity of the bilateral advancement flap to reconstruct and improves its applications and advantages.