Fish-Mouth Modification of VY Advancement Flaps Revisited

V-Y advancement flap is a procedure with widespread indications. It is a common flap used for defects of face, trunk and extremities. Many variations of this flap have been reported, depending upon the movement which it needs to undergo (pure advancement, rotation with advancement); or the number of flaps used. The flap advancement is limited by the laxity of the underlying tissues and vessels. Also, as most excisional defects are elliptical or circular, it makes closure at centre of defect difficult. There is usually some extra tissue left at the edges after advancing the flap, which is unutilised in most V-Y flaps. Here we describe the less reported use of ?horns? of extra tissue to facilitate closure of a V-Y flap. The horns on both sides are fed into the centre of the defect, which results in a fish-mouth type closure. The robust vascularity of a V flap provides circulation to these ?horns?. In areas where sufficient tissue for making a long enough V-flap is not available, this modification can be used. This technique is also useful when the flap advancement is limited or when closure at the centre of defect becomes difficult.