title: The V-Y advancement flap is equivalent to the Mustardé flap for ectropion prevention in the reconstruction of moderate-size lid-cheek junction defects.
abstract: BACKGROUND
  Lid-cheek junction defects represent a reconstructive challenge because of the susceptibility of the lower eyelid to ectropion. To minimize the inferior tension placed on the lid margin, classic teaching advocates for the use of cervicofacial rotation-advancement flaps as popularized by Mustardé. Despite this approach, ectropion can still be problematic, and elevation of the cheek poses its own set of potential complications. An inferior-to-superior V-Y advancement flap has also been described, but its use is often limited because of the perceived increased risk of ectropion. This study attempts to define this risk by investigating the incidence of postoperative ectropion between cervicofacial and V-Y flaps for the reconstruction of lid-cheek junction defects.
  
  
  METHODS
  All patients who underwent reconstruction of lid-cheek junction defects performed by the senior author (D.L.B.) between January of 2002 and March of 2009 were reviewed retrospectively. Only cervicofacial (n = 11) and V-Y flaps (n = 23) were included in the analysis. Patient demographics, defect size, operative time, hospital stay, and postoperative complications were extracted from the clinical record.
  
  
  RESULTS
  Nine patients in the cervicofacial group (82 percent) and three patients in the V-Y group (13 percent) experienced a postoperative complication (p = 0.0002). Three cases of ectropion were observed, including two patients in the cervicofacial group (18 percent) and one in the V-Y group (4 percent, p = 0.24). All cases resolved with conservative management.
  
  
  CONCLUSIONS
  No difference in ectropion rate was found between the cervicofacial and V-Y groups. The versatility of the V-Y advancement flap is perhaps underestimated in this clinical context.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Ann Arbor, Mich. From the Section of Plastic and Reconstructive Surgery, University of Michigan Health System.
authors.forename: Kristoffer B
authors.initials: KB
authors.lastname: Sugg
authors.forename: Paul S
authors.initials: PS
authors.lastname: Cederna
authors.forename: David L
authors.initials: DL
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002610:Cheek; D004483:Ectropion / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005143:Eyelids; D005153:Facial Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000601:surgery*; D013524:Surgical Flaps / Q000637:transplantation*; D016896:Treatment Outcome