BACKGROUND. The optimal design of a skin flap requires an understanding of the concepts of tissue movement. OBJECTIVE. The purpose of this manuscript was to demonstrate concepts of sliding and lifting tissue movement for flap reconstruction. METHODS. Six similar defects located in the forehead-temple- eyebrow region were repaired using a different skin flap. RESULTS. The specific flap design for a given defect is based on the answer to three predictable events that result from tissue transfer: Where is the tension? Where are the final incision lines? Where is the redundant tissue? CONCLUSION. A mental exercise assessing all available reconstruction options should be performed for each individual patient and defect. Both patient and defect considerations need to be assessed. A thorough understanding of both anatomy and tissue movement is necessary for optimal skin flap reconstruction.
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