Turnover adipofascial flap. A, Complex defect. B, Design of adipofascial flap. Flap base is immediately proximal to the defect, and flap width is slightly wider than the defect. C, Development of a distally based flap by separating it from the underlying paratenon of the extensor tendon. (Intact paratenon ensures tendon gliding after surgery.) D, Flap is turned over on itself to cover the defect and the flap base. E, Flap covered with thin skin graft. Skin closure is not performed at base of flap to avoid tension. SEE TECHNIQUE 19.4.