Eur J Plast Surg (1998) 21:132±135
Amplified V-Y flaps for nasal defects
Received: 2 May 1997 / Accepted: 22 July 1997
D.H. Park (
Department of Plastic and Reconstructive Surgery,
Catholic University of Taego Hyosung, College of Medicine,
Tel- +82-53-650-4581; Fax +82-53-623-7507
3056 Taemyung 4-dong, Namgu, Taegu 705-034, Korea
Abstract Due to a paucity of subcutaneous tissue in the
nose, mobilization of some flaps is impeded and large na-
sal defects are thus difficult to close with traditional V-Y
flaps. The V-Y flap is modified by the addition of an am-
plified limb onto the advancing edge of the V-Y flap. This
limb is located adjacent to the area requiring reconstruc-
tion and is hinged down on the end of the V-Y flap to
close the distal portion of the defect. The amplified V-Y
flap, a modified V-Y advancement flap, is very useful
for the closure of relatively large defects on the nasal ar-
ea. We have used this flap for nasal defects as large as
2.5 cm in diameter following excision of skin tumors on
the nose in 11 patients. Most excised tumors were basal
cell carcinomas. The results have been quite good, with
only minor complications in two patients. Complications
were encountered only in the nasal tip region, there was
partial necrosis at the tip of the amplified portion of the
flap. The modifications of the V-Y flap described has ex-
tended the application in closing nasal defects.
Key words Amplified V-Y flaps ´ Nasal area
The nose is a difficult anatomic region in which to close
defects resulting from resection of cutaneous malignan-
cies. Esser was the first to describe the use of V-Y flaps,
and many authors have further refined the technique and
its applications [2±4, 6±13, 21].
The use of adjacent skin as the V-Y flap to repair soft
tissue defects in the nose yields good cosmetic results and
the limits of the V-Y flaps are related to the capacity of
excursion in the advancement.
The mobility of the V-Y flap is decreased in the nasal
area because there is a paucity of subcutaneous tissue in
the nasal area and this results in considerable tension
when the V-Y flap is used. In addition, many defects in
the nasal areas are too large for a traditional V-Y flap.
An amplified sliding flap was first introduced by Campus
et al. . They added the triangular amplified limb to the
conventional V-Y flap. The disadvantages of the ampli-
fied sliding flap included the large scar, and an increased
vascular risk in the apical areas of the two distal flaps.
We have modified the shape of the amplified sliding
flap following a geometrical analysis, to overcome the
disadvantage of the amplified sliding flap. We replaced
the triangular with a quadrilateral amplified limb in order
to decrease the risk of vascular insufficiency and scarring.
The principle of the amplified V-Y flap for repair of
nasal defects relies on both V-Y advancement and trans-
position. This is similar to the extended V-Y flap tech-
nique described by Pribaz et al. in 1992 . They did
not show a schematic diagram of the design of their tech-
nique, but only clinical examples in the temporal, scalp,
forehead, and nasal areas.
An original diagram of the amplified V-Y flap as well
as 11 illustrative cases of its use are included in this
Material and methods
The length and long axis of the amplified V-Y flap is the same as the
traditional V-Y flap. The width of the amplified V-Y flap should be
greater than the width of the defect owing to the presence of an am-
plified quadrilateral limb of the flap along the sides of the defect.
The width of this amplification is dependent on the degree of mobil-
ity of the V-Y flap.
The length of the amplified limb in an amplified V-Y flap is ap-
proximately half the width of the defect according to patterns of the
defect (Fig. 1). The amplified limb of a unilateral flap can be located
on either side of the defect depending on the anatomic location. The
length of unilateral amplification is approximately the width of the
defect (Fig. 2).