title: Croissant-shaped v-y advancement flap with 2 horns for repair of small- and medium-sized facial defects.
abstract: BACKGROUND
  The use of a V-Y advancement flap is an effective technique for the reconstruction of small facial defects. However, in some areas, the use of a conventional V-Y advancement flap is not possible because of the tension caused by size variation. In the current study, we modified this method using a croissant-shaped V-Y advancement flap and repaired intermediate-sized defects without difficulty.
  
  
  METHODS
  A croissant-shaped modified V-Y flap was used in 15 patients (aged 53-82 y). To completely remove masses, wide excisions were performed in all cases (nasolabial area = 7, nasojugal area = 3, medial canthal area = 1, cheek = 2, nose = 1, forehead = 1), and the average size of the defects was 2.6 × 2.5 cm. The flap was designed after confirmation of clear resection margins on frozen section. The long axis of the V-flap was 1.5 to 2 times the length of the diameter of the defect and parallel to the nasolabial or nasojugal fold. In a conventional V-Y advancement flap, the lateral limbs of the V-flap begin at the end point of the central limb. However, in our design, the incision lines of the lateral limbs of the V-flap were extended to the end point of the defect to form a more convex shape. The flap was elevated in the subcutaneous layer above the mimetic muscles. The bilateral tips of the horns of the V-flap were sutured to each other and fixed medially to cover the distal aspect of the defect. The flap was then sutured with a 6-0 nylon. Donor site closure was performed with 6-0 Vicryl and 6-0 nylon in 2 layers. A Penrose drain was inserted at the donor site.
  
  
  RESULTS
  No complications were reported in any of the 15 cases. In 2 cases, there was minimal flap congestion immediately after surgery. However, in both cases, the congestion spontaneously resolved during the ensuing days. At follow-up (mean, 12 mo), all 15 patients demonstrated satisfactory cosmetic results.
  
  
  CONCLUSIONS
  This modified croissant-shaped V-Y flap may serve as an alternative to conventional V-Y flaps for reconstruction of soft tissue defects on the face.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Yonsei University, Wonju College of Medicine, Wonju, Korea.
authors.forename: Ji-Ye
authors.initials: JY
authors.lastname: Kim
authors.forename: Seum
authors.initials: S
authors.lastname: Chung
authors.forename: Yoon-Kyu
authors.initials: YK
authors.lastname: Chung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005153:Facial Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013524:Surgical Flaps; D013536:Suture Techniques; D016896:Treatment Outcome