Burows UAdvancement

The U-shaped skin advancement requires the excision of two Burow's triangles (Fig. 3.2a). The length-to-width ratio of the standard U-flap should not exceed 2: 1, and a 3: 1 ratio is allowed only in exceptional cases.

In the Stark modification of the U-advancement (quoted in Jost et al. 1977), the flap is widened toward its base. Cut-backs can be added to increase the flap length (Fig. 3.3a). The extra small defects created by the flap are closed by mobilizing the surrounding skin (Fig. 3.3b). Other modifications are shown in Figures 3.4-3.7.

Advancement Flap

Fig. 3.1 Advancement flap of Burow (1855). a The flap is incised along the base of the wedge-shaped defect, and a small Burow's triangle (arrow) is excised on the opposite side. The skin is mobilized and shifted in the direction of the arrow to close the defect. Excising the small Burow's triangle eliminates a dog ear at the base of the flap. b Appearance after coverage of the defect.

Fig. 3.1 Advancement flap of Burow (1855). a The flap is incised along the base of the wedge-shaped defect, and a small Burow's triangle (arrow) is excised on the opposite side. The skin is mobilized and shifted in the direction of the arrow to close the defect. Excising the small Burow's triangle eliminates a dog ear at the base of the flap. b Appearance after coverage of the defect.

Figs. 3.3-3.5 Modifications of defect closure using Burow's triangles.

3.6
3.7

Figs. 3.6 and 3.7 Modifications of defect closure using Burow's triangles.

Figs. 3.6 and 3.7 Modifications of defect closure using Burow's triangles.

Pic Advancement Flap

Fig. 3.8 V-Y advancement a A contracted scar or the frenulum can be lengthened by making a V-shaped incision, mobilizing the flap, and advancing it in the direction of the arrow. b The skin is mobilized. c Closure of the defects.

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