Fig. 4. V-Y-S (A and B) and subcutaneous pedicle flap (C and D). Circular defect with ellipse outlined. A. Flaps incised and rotated. B. V-Y closure forming an S. C. Complete incision in the ellipse with advancement on subcutaneous pedicle. D. Closure using V-Y principle. This can be performed with one or two pedicles.