Mohs Micrographic Surgery Design and Execution of Pedicle Flaps

When performing Mohs micrographic facial surgery, many different closure techniques are available to preserve function and cosmesis. Island pedicle flaps, a form of advancement flap, are unique as these flaps primarily use the vascular supply from the subcutaneous tissue to prevent flap failure. Island pedicle flaps are used when repairing small- to medium-sized defects where minimal spare tissue is available, as on the face.  The traditional design of the island pedicle flap is a triangle with a short base and 2 long legs of near equal length; variations exist. The base of the triangle is advanced into the position of the primary defect. This flap design allows for convenient closure of the secondary defect because the 2 longer legs of the triangle are already positioned for a linear closure. The original incisions of the flap are V-shaped, with the resulting suture lines in the shape of a Y, which gives the island pedicle flap another name—the V-Y advancement flap. This advancement flap severs all dermal attachments around the triangular flap while leaving the subcutaneous vascular attachments on the inferior side of the flap intact.