Pedicle-lining skin grafts contract between the first and second stage in a 3-stage forehead flap nasal reconstruction. The second stage involves an inherent reduction in vascularity due to the soft tissue thinning performed. The Anterior-Posterior Dissociative Slide restores first-stage pedicle length at the second stage. Incisions are made at the distal seam between the contracted graft and the pedicle tissue. The flap is then slid caudally relative to the fixed graft, thus relengthening the pedicle. This technique has been performed in 16 patients achieving an average length gain of 0.7 (+0.2) cm. The additional length created with the dissociative slide translates into reduced tension with flap reinset, thus increasing flap workability and overall artistry in the second stage.
From the *Seton Institute of Reconstructive and Plastic Surgery, and †Seton Family of Hospitals, University of Texas Southwestern Austin, Austin, TX.
Received July 2, 2012, and accepted for publication, after revision, April 29, 2013.
Conflicts of interest and sources of funding: none declared.
Reprints: Adam Bryce Weinfeld, MD, Seton Institute of Reconstructive and Plastic Surgery, 1400 N Interstate 35, Austin, TX 78701. E-mail: firstname.lastname@example.org.