More substantial defects, or those that also involve soft tissue, bone, and nerve, usually are repaired with axial pattern flaps, regional flaps, or revascularized free flaps.
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.