title: The 'note flap'.
abstract: A versatile local skin flap for the closure of facial defects is presented. A tangent is drawn to the edge of a circular defect parallel to the relaxed skin tension lines for a distance of 1.5 diameter (d); a second line of length d is drawn at 50 degrees to 60 degrees to the first to create a triangular flap. The final flap design when drawn resembles an eighth note. The tip of the flap is de-epithelialized to facilitate closure. Two opposing flaps can be used for a larger defect if desired. In a series of 20 consecutive patients, the mean length of the first side of the flap was 1.4d, the length of the second was 1.1d, and the mean tip angle was 50.3 degrees. The area of this average flap is approximately 75% of the area of the circular defect. Skin deformation measured on piglets showed the major tension vector to be perpendicular to the tangential side of the triangular flap.
mesh_terms: D000818:Animals; D005260:Female; D006801:Humans; D008297:Male; D013518:Surgery, Plastic / Q000379:methods*; D013524:Surgical Flaps; D013552:Swine