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Subject: Advancement Flaps
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Surgery tray instruments are listed in Appendix G. Consider adding skin hooks to gently handle the skin flaps. Have at least three fine (mosquito) hemostats to assist with hemostasis while developing large skin flaps.
Suggested suture removal times are listed in Appendix J, and a suggested anesthesia tray that can be used for this procedure is listed in Appendix F. All instruments can be ordered through local surgical supply houses.
Closure of skin defects that require skin pull in line with the long axis of the lesion
Closure of eyebrow defects
Repair of defects of the temple area
Closure of forehead defects
Closure of cheek defects
Closure of upper arm defects
Closure of defects on the tip of the nose
Closure of defects on the trunk or abdomen
Closure of forehead skin defects
Practitioner’s unfamiliarity or inexperience with techniques
Cellulitis in the tissues
Skin unable to be stretched to cover the defect
Chronic steroid use (and steroid skin effects)
PEARL: Prep a wide area so that an undraped area is not inadvertently exposed if the drape slides a little.
PEARL: Some skin surgeons excise the original lesion in a square, which gives additional tissue in which to get clean margins. This is often easier if the long arms of the H-shape of the flaps are cut first and then the center cuts made connecting the two long arms. This greatly decreases the risk of positive margins.
PITFALL: If there is tension on the flap, vertical mattress sutures can be placed instead of simple interrupted sutures to increase blood flow at the suture line (see Vertical Mattress Suture).
PITFALL: The skin often bunches up (i.e., dog ears) near the base of the flap. These dog ears are eliminated by excising triangular pieces of skin (i.e., Burrow triangles) (see Burrow’s Triangle (Dog Ear) Repair).
Pain, infection, and bleeding
Nonunion of skin edges