Background: Tissue redundancy manifesting as a standing cutaneous cone is a common surgical problem.
Objective: We describe modifications to traditional advancement flap design that allows for standing cutaneous cone avoidance.
Methods: In addition to traditional incisions employed in advancement flaps, an additional curvilinear incision is made along one or more limbs of the flap. By removing tissue along the length of the flap incision, redundant tissue is redistributed along the length of the incision. A standing cutaneous cone is thereby avoided.
Results: Use of the technique provides standing cone avoidance without lengthening a surgical scar. There has been no increase in flap failure or other complications with the described technique.
Conclusion: The modified advancement flap allows for standing cone avoidance. Improved cosmesis can also be achieved when the modified flap limb is placed in a facial line or subunit junction.