An Effective Option for the Repair of Facial Defects: V-Y Advancement Flaps and Modifications

Abstract

Objective: V-Y advancement flaps are pliable local flaps that can be used in nearly every part of the body with relatively minimal technical difficulty. These flaps provide the best color and quality match, especially in the facial region. With effective planning, donor site morbidity can be acceptable, even on the face.
Methods: The results of 38 patients who underwent 53 V-Y advancement flap facial reconstructions were analyzed retrospectively. The defects were evaluated according to their anatomical region, etiology, postoperative complications, and final aesthetic results.
Results: V-Y advancement flaps were used for defects that were either not amenable to primary repair or had a high risk of cosmetic distortion. The defects were located in the cheek (9 patients), nasolabial fold (7 patients), nose (6 patients), forehead (5 patients), preauricular area (3 patients), infraorbital region (3 patients), lower lip (1 patients), gingivobuccal sulcus (2 patients), and medial canthal region (2 patients). In 32 patients, the primary pathology was malignant tumor (22 basal cell carcinomas, 9 epidermoid carcinomas, 1 malignant eccrine poroma). Etiologies of the other patients’ defects were benign tumors (n=2), traumatic wounds (n=2), and contractures (n=2).
Conclusions: Despite the widespread use of V-Y flaps in surgical practice, the technique continues to demonstrate additional advantages, particularly in facial reconstruction. They are not only applicable for medium and small defects, but can be used for all defects with sufficient surrounding tissue. They enable various modifications and the elevation of multiple flaps.

Keywords

• Surgical flaps,reconstructive surgical procedures,face

References

1. 1. Rao JK, Shende KS. Overview of Local Flaps of the Face for Reconstruction of Cutaneous Malignancies: Single Institutional Experience of Seventy Cases. J Cutan Aesthet Surg 2016;9:220-5.
2. 2. Venkataramakrishnan V, Mohan D, Villafane O. Perforator based V-Y advancement flaps in the leg. Br J Plast Surg 1998;51:431-5.
3. 3. Akan IM, Ulusoy MG, Bilen BT, Kapucu MR. Modified bilateral advancement flap: the slide-in flap. Ann Plast Surg 1999;42:545-8.
4. 4. Emmett AJ. The closure of defects by using adjacent triangular flaps with subcutaneous pedicles. Plast Reconstr Surg 1977;59:45-52.
5. 5. Ulusoy MG, Akan IM, Sensöz O, Ozdemir R. Bilateral, extended V-Y advancement flap. Ann Plast Surg 2001;46:5-8.
6. 6. Ichioka S, Okabe K, Tsuji S, Ohura N, Nakatsuka T. Distal perforator-based fasciocutaneous V-Y flap for treatment of sacral pressure ulcers. Plast Reconstr Surg 2004;114:906-9.
7. 7. Kimyai-Asadi A, Goldberg LH. Island pedicle flap. Dermatol Clin 2005;23:113-27.
8. 8. Sugg KB, Cederna PS, Brown DL. The V-Y advancement flap is equivalent to the Mustardé flap for ectropion prevention in the reconstruction of moderate-size lid-cheek junction defects. Plast Reconstr Surg 2013;131:28-36.

9. 9. Menick FJ. Defects of the nose, lip, and cheek: rebuilding the composite defect. Plast Reconstr Surg 2007;120:887-98.
10. 10. Kalus R, Zamora S. Aesthetic considerations in facial reconstructive surgery:the V-Y flap revisited. Aesthetic Plast Surg 1996;20:83-6.
11. 11. Chang JW, Lim JH, Lee JH. Reconstruction of midface defects using local flaps: an algorithm for appropriate flap choice. Medicine (Baltimore) 2019;98:18021.
12. 12. Hintschich C. Correction of entropion and ectropion. Dev Ophthalmol 2008;41:85-102.
13. 13. Robinson JK. Suspension sutures in facial reconstruction. Dermatol Surg 2003;29:386-93.
14. 14. Harris GJ, Perez N. Anchored flaps in post-Mohs reconstruction of the lower eyelid, cheek, and lateral canthus: avoiding eyelid distortion. Ophthalmic Plast Reconstr Surg 2003;19:5-13.
15. 15. Hudson DA, Quarmby C, Ndobe E. A suture suspension technique to prevent ectropion after flap transposition from the neck to the face. Plast Reconstr Surg 2001;108:1692-5.
16. 16. Salasche SJ, Jarchow R, Feldman BD, Devine-Rust MJ, Adnot J. The suspension suture. J Dermatol Surg Oncol 1987;13:973-8.
17. 17. Hayano SM, Whipple KM, Korn BS, Kikkawa DO. Principles of Periocular Reconstruction following Excision of Cutaneous Malignancy. J Skin Cancer 2012;2012:438502.
18. 18. Czyz CN, Cahill KV, Foster JA, Michels KS, Clark CM, Rich NE. Reconstructive options for the medial canthus and eyelids following tumor excision. Saudi J Ophthalmol 2011;25:67-74.
19. 19. Rubin P, Mykula R, Griffiths RW. Ectropion following excision of lower eyelid tumours and full thickness skin graft repair. Br J Plast Surg 2005;58:353-60.
20. 20. Mustardé JC. The use of flaps in the orbital region. Plast Reconstr Surg 1970;45:146-50.
21. 21. Callahan MA, Callahan A. Mustardé flap lower lid reconstruction after malignancy. Ophthalmology 1980;87:279-86.
22. 22. Peled I, Kaplan H, Wexler MR. Lower eyelid reconstruction by V-Y advancement cheek flap. Ann Plast Surg 1980;5:321-3.
23. 23. Acikel C, Celikoz B, Yildiz TF. Y-shape hard palate mucoperiosteal graft and V-Y advancement flap in the reconstruction of a combined defect involving lateral canthus and upper and lower eyelids. Ann Plast Surg 2004;52:97-101.
24. 24. Marchac D, de Lange A, Bine-bine H. A horizontal V-Y advancement lower eyelid flap. Plast Reconstr Surg 2009;124:1133-41.
25. 25. Monarca C, Rizzo MI, Marcasciano M, Parisi P, Ruggiero M, Scuderi N. A horizontal V-Y advancement lower eyelid flap: our experience performing a bilateral suspension to the periosteum. Plast Reconstr Surg 2012;130:178-80.
26. 26. Karapandzic M. Reconstruction of lip defects by local arterial flaps. Br J Plast Surg 1974;27:93-7.
27. 27. Bayramiçli M, Numanoğlu A, Tezel E. The mental V-Y island advancement flap in functional lower lip reconstruction. Plast Reconstr Surg 1997;100:1682-90.
28. 28. Bocchi A, Baccarani A, Bianco G, Castagnetti F, Papadia F. Double V-Y advancement flap in the management of lower lip reconstruction. Ann Plast Surg 2003;51:205-9.
29. 29. Fang QG, Shi S, Zhang X, Li ZN, Liu FY, Sun CF. Total lower lip reconstruction with a double mental neurovascular V-Y island advancement flap. J Oral Maxillofac Surg 2014;72:834.
30. 30. Kakudo N, Kuro A, Morimoto N, Hihara M, Kusumoto K. Combined Tongue Flap and Deepithelialized Advancement Flap for Thick Lower Lip Reconstruction. Plast Reconstr Surg Glob Open 2017;5:1513.
31. 31. Chen WL, Wang YY, Zhou M, Yang ZH, Zhang DM. Double mental neurovascular V-Y island advancement flaps combined with tongue flaps for functionally reconstructing total lower-lip defects. J Craniofac Surg 2012;23:181-3.
32. 32. Thorpe RB, Smith JM, Srivastava D. Repair of a Full-Thickness Defect of the Right Upper Lip Extending Into Multiple Cosmetic Subunits. Dermatol Surg 2019;45:731-3.
33. 33. Carvalho LM, Ramos RR, Santos ID, Brunstein F, Lima AH, Ferreira LM. V-Y advancement flap for the reconstruction of partial and full thickness defects of the upper lip. Scand J Plast Reconstr Surg Hand Surg 2002;36:28-33.
34. 34. Zeitouni NC, Ang JM, Weyer CW, Krunic AL. Horizontally Opposed V-Y Advancement Flaps for Surgical Reconstruction of Central Upper Lip Defects. J Craniofac Surg 2017;28:578-9.