A technique of undermining a V-Y subcutaneous island flap to maximise advancement

A method is described where the planned directional undermining of a subcutaneous triangular flap creates a long pedicle and in the process the flap is "unfolded" to increase its advancement. The flap can be undermined and advanced without any tension. This method is recommended where more conservative undermining is inadequate for mobilisation, particularly in larger defects and in the replacement of skin defects on the lower eyelid which needs to support the eyelid. This technique depends on the richness of the random blood supply in the head and neck regions and the availability of adequate depth of subcutaneous tissue for the development of a long pedicle. Using this method in 53 cases, it has been found possible to advance the flap way past the defect if so desired. Some minor disadvantages of this flap are also described.