Situational modification of regional flaps

A few modifications in unusual situations of regional flaps in the head and neck are demonstrated. It is the author's hope to stimulate the surgeon to use some imagination, incorporating a variety of time-proven principles and some unique situational modifications. Emphasis is placed on the continued need for the tubed pedicle flap, de-epithelialization of flaps and imbrication about the margins of the defect, and the use of the horizontally split deltopectoral flap for the simultaneous closure of internal defects and coverage of external defects for through-and-through wounds.