Many variables determine the type of repair chosen. Advancement flaps are used when the patient is in overall good health and the defect is free of tumor and obvious infection. Flaps should match thickness, color, and texture of excised skin. Resultant scars should fall in relaxed skin-tension lines. Today, advancement flaps are used widely to close skin defects of the face, scalp, and neck.
Favorable scars respect anatomical subunits of the face and lie in relaxed skin-tension lines.
Advancement flaps typically are used in forehead, scalp, eyelid, and upper lip areas. Any viable flap must have an adequate blood supply. Circulation to the skin starts with large, named, segmental vessels branching from the aorta. Segmental vessels branch to give rise to perforating arteries that run through overlying muscles. Advancement flaps are based on a random pattern blood supply, which comes from the anastomoses within the subdermal or dermal plexus.