Summary
Background
The V–Y advancement flap and, more recently, the keystone flap are commonly used to
cover skin defects. Both flaps allow for primary closure after advancement by substituting
the initial defect for a narrower defect distributed over a greater length.
The first objective of this study was to develop a geometrical analysis of the V–Y
advancement flap. The second objective was to explain the benefit of using the keystone
flap compared to a single V–Y advancement flap.
Material and method
A geometrical analysis is proposed using a two-dimensional analysis in which the flaps
are assumed to have a rigid-body behaviour. First, in the case of the V–Y advancement
flap, a trigonometric relationship is defined between the distance of closure before
and after advancement, thus implying the value of the flap's apex angle. Second, by
considering the keystone flap as the association of three V–Y advancement flaps, the
trigonometric relationship is applied to the keystone flap.
Results
In the case of the V–Y advancement flap, the optimal apex angles are between 20° and
60°. At less than 20°, the length of the flap increases in an exaggerated manner.
At greater than 60°, the distance of closure, particularly at the apex of the flap
where a corner stitch is performed, is greater than the distance of closure of the
initial defect. In the case of the keystone flap, the width of the final defect around
the flap is clearly smaller and more regular compared to the final defect around a
single V–Y advancement flap.
Conclusion
The geometrical analysis of the V–Y advancement flap in our description illustrates
the major benefit of the keystone flap over a single V–Y advancement flap.
Keywords
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Article info
Publication history
Published online: April 18, 2012
Accepted:
March 1,
2012
Received:
September 17,
2011
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
