Serial excision and advancement flaps in the management of facial lesions

Large facial lesions may be eradicated and replaced with anatomically normal-appearing adjacent skin by serial excision. The same properties that allow skin flaps to move and expand may cause undesirable spreading of lesion-bearing skin. Since scar contracture does not induce physiologic stretching of adjacent normal skin, it is more difficult to resolve third-degree burn deformities by serial excision. Certain anatomic regions present difficulties because of the relative immobility of skin and the risk of conspicuous deformity resulting from the secondary motion induced by advancement of the local flap. Discrete undermining and differential tissue approximation afford effective utilization of serial excision in these situations.