Subunit Reconstruction of Mid-Facial Defects with Free Style Facial Perforator Flaps

Introduction: Reconstruction of facial defects is not only important for cosmesis but also for the function. Local flaps are considered the best reconstruction method for facial defects. We want to show the feasibility of free style facial perforator flap for the reconstruction of moderate sized mid-facial defects.

Methods: Free style facial artery and lateral nasal artery perforator flaps were performed in 22 patients (11 males and 11 females) who had removal of facial tumor between March 2015 and December 2016. Facial artery perforator flaps were used for the defects of nasal dorsum, nasolabial area, medial cheek and lower eyelid. Those flaps were advanced in V-Y fashion to close the defect[1]. Lateral nasal artery perforator flaps were used for the defects of nasal sidewall and nasal wing. Those flaps were transferred to the defect with propeller movement[2].

Results: The median age of patients was 62 years (range: 35-84 years). The mean follow-up period was 12.6 months (range: 5-24 months). Pathology results were basal cell carcinoma in thirteen patients, squamous cell carcinoma in six patients and other skin tumors in three patients. The defect size ranged from 2 x 2 to 5 x 5cm. No major or minor complication happened but one flap had venous congestion that healed without any intervention

Conclusion: The face consists of six major aesthetic units [2]. Cheek is one of them and it is comprised of medial, zygomatic, lateral and buccal subunits. In our study, we mostly reconstructed the medial subunit of the cheek and we believe that V-Y advancement results in more aesthetically appealing scar by reconstructing the subunit with alike tissue. Especially for larger defects of medial cheek or combined defects of cheek and other regions (such as nasal sidewall, lower eyelid, etc), V-Y closure should be preferred over propeller flap. Free style facial perforator flaps are highly reliable flaps with wide range of motion[4,5]. In addition, they provide single stage closure with aesthetic subunit reconstruction. With the current knowledge of reconstruction and skills of microsurgery, they can be easily the first choice for the closure of mid-facial defects.

 

 

 

 

References:

 

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