D. Oudit Æ G. Ross Æ M. Ellabban Æ M. Berry
A. M. Juma
A modiﬁcation of the V-Y advancement ﬂap to cover a defect
of the outer canthus and both eyelids
Received: 3 March 2004 / Accepted: 16 December 2004 / Published online: 19 April 2005
Ó Springer-Verlag 2005
Abstract We describe the use of a modiﬁed V-Y
advancement ﬂap from the lateral aspect of the outer
canthus to cover a defect with three components on the
lateral aspects of the upper and lower eyelids and the
outer canthus of the eye.
Keywords V-Y advancement ﬂap Æ Outer canthus Æ
Eyelids Æ Local ﬂap
The V-Y advancement ﬂap is a type of local ﬂap en-
abling transfer of tissue without rotation or lateral
movement to an adjacent site. It has been used suc-
cessfully to cover soft-tissue defects. Various modiﬁca-
tions of this ﬂap have been described in the literature for
use in speciﬁc situations [1–6]. We describe a case in
which a modiﬁed V-Y advancement ﬂap was used in a
primary procedure to simultaneously cover a soft-tissue
defect involving the soft skin of the lateral canthus and
the lateral aspects of both the upper and lower eyelids.
A 71-year-old gentleman presented with multiple lesions
on his face and neck secondary to immunosuppressant
treatment following a cardiac transplant 15 years ago.
All of the lesions (involving the nose, forehead, cheek,
neck and left eyebrow) were excised with the appropriate
oncological safety margins and were all closed directly,
apart from a lesion involving the lateral canthus and the
lateral aspects of the upper and lower eyelids on the
right side (Fig. 1).
This lesion was excised with a 2 mm margin, and the
defect reconstructed using a modiﬁed V-Y advancement
ﬂap. No further corrective measures have been per-
formed and he has adequate lid support with no func-
tional deﬁcit 3 months post-operatively.
The lesion on the outer aspect of the lateral canthus of
the right eye was excised with a 2 mm margin, leaving a
defect involving the lateral aspects of the upper (25%)
and lower eyelids (30%) as well as the intervening seg-
ment of the skin overlying the lateral canthus. The
supporting mechanism of the lateral canthus was pre-
This defect was reconstructed with a local V-Y ﬂap
which was advanced 2 cm medially. The medial aspect
of the V-Y advancement ﬂap was partially bisected to
create two limbs with superior and inferior components.
These were used to cover the defects on the upper and
lower eyelids respectively. The lateral aspect of the
V-component was used to cover the defect on the lateral
canthus. The donor defect (the Y-component) was
closed directly, producing a scar along the natural skin
creases (Fig. 2). The defect of the posterior lamellae was
reconstructed using a conventional conjunctival
advancement procedure. The postoperative appearance
1 year later is shown in Figs. 3 and 4.
The V-Y advancement ﬂap is a commonly-used local
ﬂap in facial reconstruction. There have been several
reports of modiﬁcations of this ﬂap based on the need to
cover various types of defects [1–7].
D. Oudit Æ G. Ross Æ M. Ellabban Æ M. Berry Æ A. M. Juma (&)
Department of Plastic and Reconstructive Surgery,
Lancashire Teaching Hospitals, Royal Preston Hospital,
Sharoe Green Lane, North Fulwood, Preston,
Lancashire, PR2 9HT, UK
Eur J Plast Surg (2005) 27: 383–386