Abstract
Utilization of advancement flaps to cover facial defects is potentially limited by the secondary distortion of adjacent anatomical landmarks, expansion of any residual lesion, and the vascular embarrassment of wound closure under tension. In this study, advancement flaps are raised in piglets, and the first stage in the serial excision of a hypothetical skin lesion is simulated. It is demonstrated that undermining of the lesion-bearing skin results in expansion of the lesion and is counterproductive. If, however, a separate layer of hypodermis and fascia is mobilized deep to the lesion and sutured to the advancing flap, skin closure can be accomplished with minimal tension. This results in maximal recruitment of the advancement flap and minimal expansion of the residual lesion as the defect is bridged.
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