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Multiple elements contribute to flap failure. Poor flap design is certainly one of the commonest causes of flap failure. Insufficient flap size, violation of the blood provide to the flap, or design of the flap in radiated or traumatized tissue often causes early problems within the surgical process. Technical errors similar to injuring the blood provide during dissection, creating an excessive amount of tension on the flap, or twisting or kinking the flap pedicle could cause flap ischemia and necrosis. Hematoma may cause pressure on the flap and lead to necrosis. Infection also can cause partial or full flap necrosis. The donor site is one other potential supply of complications (eg, important scarring, wound dehiscence, poor skin graft acceptance if the wound was grafted). Advancement flap: The rectangular flap advances right into a rectangular defect. The purple triangular excisions are Burow triangles, which could also be used to regulate the tension of closure. 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