BACKGROUND. Transposition flaps are powerful reconstructive tools that are frequently called on in cutaneous reconstruction. Transposition flaps tap into adjacent areas that may have relative laxity while redirecting the vectors of tension during closure. OBJECTIVE. As with the closure of any surgical defect, the goal is to achieve the best possible functional and esthetic result. MATERIALS AND METHODS. Manual manipulation is used to "feel" for areas of relative laxity and test the effects of various tension vectors on adjacent structures. Every effort should be made to avoid distortion of the free margins of structures such as the nose and eyelids. Consideration must be taken to best camouflage incision lines within existing lines or creases, at the junction of cosmetic units, or at least parallel to lines of relaxed skin tension. CONCLUSIONS. A complete knowledge of the possible variations and modifications of transposition flaps can help fine-tune the execution of the flap to provide the patient with the best possible result. Good surgical technique and proper wound eversion through meticulous suture placement also help tremendously in consistently attaining esthetically pleasing results. At the surgical bedside, an artistic eye should meet the science of cutaneous biomechanics.
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