Background: The optimal design of a skin flap requires an understanding of the concepts of tissue movement.
Objective: The purpose of this manuscript was to demonstrate concepts of sliding and lifting tissue movement for flap reconstruction.
Methods: Six similar defects located in the forehead-temple-eyebrow region were repaired using a different skin flap.
Results: The specific flap design for a given defect is based on the answer to three predictable events that result from tissue transfer: Where is the tension? Where are the final incision lines? Where is the redundant tissue?
Conclusion: A mental exercise assessing all available reconstruction options should be performed for each individual patient and defect. Both patient and defect considerations need to be assessed. A thorough understanding of both anatomy and tissue movement is necessary for optimal skin flap reconstruction.