Flaps may be revised later. If a long or tenuous flap is contemplated, surgeons may want to raise the flap in one procedure and wait 1-3 weeks before advancing the flap. This action takes advantage of the delay phenomenon, which increases flap survival. The exact mechanism of the delay phenomenon is unknown, but it may work by opening choked vessels within the flap, thus increasing flap perfusion. Scar dermabrasion may be offered to patients generally no earlier than 6 weeks postoperatively.
Failure generally is unpredictable.
Vascular insufficiency is the main cause of flap failure and may result from undermining in the wrong plane, excessive tension on the flap, hematoma, infection, or compression of the pedicle. The advancement flap is a valuable tool for the surgeon repairing skin defects in the head and neck region. Proper patient selection and planning are essential. Advancement flaps are desirable because skin advanced from adjacent areas is usually a good match for color, thickness, and texture. Incisions can be hidden well in relaxed skin-tension lines or in borders of facial aesthetic units.