Importance: Burow's advancement flap is a frequently used and versatile flap in cutaneous surgery because it provides an excellent method for repair of large defects in proximity to free margins. Its execution typically requires excision of 2 standing cones, which increases scarring and flap size. We describe a modification of this flap achieved with a simple, reproducible suturing technique that eliminates one of the standing cones and both minimizes suture lines and optimizes cosmesis at a variety of surgical sites.
Observations: We describe 5 cases in which we successfully used our modified Burow's advancement flap to repair Mohs surgical defects in various cosmetic subunits of the face.
Conclusions and relevance: A simple suturing technique is proposed that can eliminate the need for a secondary triangle in Burow's advancement flaps. By implementing the "rule of halves" in suturing wound edges of unequal length, one can evenly distribute redundant tissue along the length of the flap, which avoids additional incisions, minimizes scarring, and allows for repair within a single cosmetic subunit.
Level of evidence: NA.