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Article
January 1988

Undermining Subcutaneous Island Flaps

Author Affiliations

Department of Dermatology Stanford University Medical Center Stanford, CA 94305

Arch Dermatol. 1988;124(1):20-21. doi:10.1001/archderm.1988.01670010010003
Abstract

To the Editor.—  The concept of the unipedicled subcutaneous island pedicle flap as recently reviewed is a difficult one to lay to rest.1 All too frequently this island pedicle flap and its many variations heal with bulkiness that is visually obtrusive. In many circumstances, multiple ancillary incisions as shown in the authors' diagrams unnecessarily violate the natural lines of the face.My disenchantment with the bulkiness brought me to a different concept than that espoused in the reference articles quoted, and by the authors themselves. Specifically, they made the statement "care must be taken not to undermine any portion of the island skin." Beginning about 1975, this precise undermining maneuver was undertaken by me to increase the mobility of the island above it (Fig 1), gradually developing the concept of dual neurovascular pedicles slanting off laterally into the subcutaneous tissue (Fig 2).2 Enough dissection and freeing of the

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