Island Flap

An island flap from the cheek is also useful for reconstructing small defects in the nasal flank area. The flap may be based on the facial artery or may be designed with a subcutaneous pedicle that has an in-ferolateral or superolateral position in relation to the

Fig. 5.30a, b U-advancement flap. Burow's triangles are excised from the nasolabial fold and nasal flank.

Fig. 5.31 a-c Double transposition flap with V-Y advancement.

flap. The skin between the flap and the defect is undermined, and the pedicle is pulled through. Care is taken not to place excessive torsion or pressure on the flap pedicle. Because the subcutaneous pedicle often creates fullness at the pull-through site, this is not one of our favorite flaps. The cheek must be mobilized somewhat more widely than with other flaps to avoid distorting the upper lip.

Cheek Island Pedicle

Fig. 5.32 Island flap on a subcutaneous pedicle.

a The pedicle is undermined (red arrow) to create a tunnel. b The flap is inset into the defect, and the donor site is closed primarily. (The flap can also be designed as an axial pattern flap based on the facial artery.)

Fig. 5.32 Island flap on a subcutaneous pedicle.

a The pedicle is undermined (red arrow) to create a tunnel. b The flap is inset into the defect, and the donor site is closed primarily. (The flap can also be designed as an axial pattern flap based on the facial artery.)

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