Prefabricated Neck Expanded Skin Flap with the Superficial Temporal Vessels for Facial Resurfacing

 

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Abstract

Background The achievement of a normal-appearing face after surgical resurfacing remains an elusive goal. This is due in part to insufficient color matching, restoration of contours, and the persistence of visible scars. Flap prefabrication is a staged procedure that provides an independent axial blood supply to local expanded tissues. We describe a new reconstructive alternative with superior reconstructive surgical options for facial resurfacing that better matches damaged or discarded facial tissues.

Methods A superficial temporal fascial flap was harvested as the vascular supply of the prefabricated neck flap and located in a subcutaneous neck pocket over a tissue expander. After a 5-month period for expansion and maturation, the prefabricated skin flap was raised, islanded, and rotated to resurface the facial defect.

Results Four patients with hemifacial postburn contracture and two patients affected by hemifacial vascular malformations aged 17 to 42 years (mean 29 years) were successfully treated with no major complication after a mean period of 15 months.

Conclusion Prefabricated neck-expanded skin flap demonstrated an excellent color and texture match with facial skin that surrounded the repair sites, and optimal aesthetic results were obtained. Importantly, facial expression was completely maintained due to thinness and pliability of the rotated skin.

• References

• 1 Guo L, Pribaz J. Preexpanded ultra-thin supraclavicular flaps for (full-) face reconstruction with reduced donor-site morbidity and without the need for microsurgery (Discussion). Plast Reconstr Surg 2005; 115: 1845-1847
  MissingFormLabel

  PubMedSearch in Google Scholar
• 2 Rose EH. Aesthetic restoration of the severely disfigured face in burn victims: a comprehensive strategy. Plast Reconstr Surg 1995; 96: 1573-1585 , discussion 1586–1587
  MissingFormLabel

  CrossrefPubMedSearch in Google Scholar
• 3 Pallua N, Machens HG, Rennekampff O, Becker M, Berger A. The fasciocutaneous supraclavicular artery island flap for releasing postburn mentosternal contractures. Plast Reconstr Surg 1997; 99: 1878-1884 , discussion 1885–1886
  MissingFormLabel

  CrossrefPubMedSearch in Google Scholar
• 4 MacLennan SE, Corcoran JF, Neale HW. Tissue expansion in head and neck burn reconstruction. Clin Plast Surg 2000; 27: 121-132
  MissingFormLabel

  PubMedSearch in Google Scholar
• 5 Vinh VQ, Ogawa R, Van Anh T, Hyakusoku H. Reconstruction of neck scar contractures using supraclavicular flaps: retrospective study of 30 cases. Plast Reconstr Surg 2007; 119: 130-135
  MissingFormLabel

  CrossrefPubMedSearch in Google Scholar
• 6 Pallua N, von Heimburg D. Pre-expanded ultra-thin supraclavicular flaps for (full-) face reconstruction with reduced donor-site morbidity and without the need for microsurgery. Plast Reconstr Surg 2005; 115: 1837-1844 , discussion 1845–1847
  MissingFormLabel

  CrossrefPubMedSearch in Google Scholar
• 7 Yao ST. Microvascular transplantation of prefabricated free thigh flap. Plast Reconstr Surg 1982; 69: 568-569
  MissingFormLabel

  PubMedSearch in Google Scholar
• 8 Erol OO. The transformation of a free skin graft into a vascularized pedicled flap. Plast Reconstr Surg 1976; 58: 470-477
  MissingFormLabel

  CrossrefPubMedSearch in Google Scholar
• 9 Orgill DP, Pribaz JJ. The expanded supraclavicular flap, prefabricated with thoracoacromial vessels, for reconstruction of postburn of postburn anterior cervical contractures (Discussion). Plast Reconstr Surg 2007; Jun; 119 (7) 2078-9
  MissingFormLabel

  PubMedSearch in Google Scholar
• 10 Topalan M, Guven E, Demirtas Y. Hemifacial resurfacing with prefabricated induced expanded supraclavicular skin flap. Plast Reconstr Surg 2010; 125: 1429-1438
  MissingFormLabel

  CrossrefPubMedSearch in Google Scholar
• 11 Margulis A, Agam K, Icekson M, Dotan L, Yanko-Arzi R, Neuman R. The expanded supraclavicular flap, prefabricated with thoracoacromial vessels, for reconstruction of postburn anterior cervical contractures. Plast Reconstr Surg 2007; 119: 2072-2077
  MissingFormLabel

  CrossrefPubMedSearch in Google Scholar
• 12 Li Q, Zan T, Gu B , et al. Face resurfacing using a cervicothoracic skin flap prefabricated by lateral thigh fascial flap and tissue expander. Microsurgery 2009; 29: 515-523
  MissingFormLabel

  CrossrefPubMedSearch in Google Scholar
• 13 Hu X, Jiang C, Lin X , et al. Reconstruction of the cheek after large port-wine stain lesion resection. Aesthetic Plast Surg 2011; 35: 795-801
  MissingFormLabel

  CrossrefPubMedSearch in Google Scholar
• 14 Teot L, Cherenfant E, Otman S, Giovannini UM. Prefabricated vascularised supraclavicular flaps for face resurfacing after postburns scarring. Lancet 2000; 355: 1695-1696
  MissingFormLabel

  CrossrefPubMedSearch in Google Scholar
• 15 Pribaz JJ, Fine N, Orgill DP. Flap prefabrication in the head and neck: a 10-year experience. Plast Reconstr Surg 1999; 103: 808-820
  MissingFormLabel

  CrossrefPubMedSearch in Google Scholar
• 16 Khouri RK, Ozbek MR, Hruza GJ, Young VL. Facial reconstruction with prefabricated induced expanded (PIE) supraclavicular skin flaps. Plast Reconstr Surg 1995; 95: 1007-1015 , discussion 1016–1017
  MissingFormLabel

  CrossrefPubMedSearch in Google Scholar
• 17 Sakurai H, Takeuchi M, Nakamori D , et al. Prefabricated flap for multiple facial units reconstruction using a jejunal seromuscular patch as a vascular carrier. Burns 2010; 36: e31-e35
  MissingFormLabel

  CrossrefPubMedSearch in Google Scholar
• 18 Vinzenz K, Holle J, Würinger E. Reconstruction of the maxilla with prefabricated scapular flaps in noma patients. Plast Reconstr Surg 2008; 121: 1964-1973
  MissingFormLabel

  CrossrefPubMedSearch in Google Scholar
• 19 Khouri RK, Ozbek MR, Hruza GJ, Young VL. Facial reconstruction with prefabricated induced expanded (PIE) supraclavicular skin flaps. Plast Reconstr Surg 1995; 95: 1007-1015 , discussion 1016–1017
  MissingFormLabel

  CrossrefPubMedSearch in Google Scholar
• 20 Morrison WA, Penington AJ, Kumta SK, Callan P. Clinical applications and technical limitations of prefabricated flaps. Plast Reconstr Surg 1997; 99: 378-385
  MissingFormLabel

  PubMedSearch in Google Scholar
• 21 Liu Y, Jiao P, Tan X, Zhu S. Reconstruction of facial defects using prefabricated expanded flaps carried by temporoparietal fascia flaps. Plast Reconstr Surg 2009; 123: 556-561
  MissingFormLabel

  PubMedSearch in Google Scholar
• 22 Erol OO, Sira M. New capillary bed formation with a surgically constructed arteriovenous fistula. Plast Reconstr Surg 1980; 66: 109-115
  MissingFormLabel

  CrossrefPubMedSearch in Google Scholar
• 23 Austad ED. The origin of expanded tissue. Clin Plast Surg 1987; 14: 431-433
  MissingFormLabel

  PubMedSearch in Google Scholar
• 24 Rivilis I, Milkiewicz M, Boyd P , et al. Differential involvement of MMP-2 and VEGF during muscle stretch- versus shear stress-induced angiogenesis. Am J Physiol Heart Circ Physiol 2002; 283: H1430-H1438
  MissingFormLabel

  PubMedSearch in Google Scholar
• 25 Maitz PKM, Pribaz JJ, Hergrueter CA. Impact of tissue expansion on flap prefabrication: an experimental study in rabbits. Microsurgery 1996; 17: 35-40
  MissingFormLabel

  CrossrefPubMedSearch in Google Scholar
• 26 Kimura N, Hasumi T, Satoh K. Prefabricated thin flap using the transversalis fascia as a carrier. Plast Reconstr Surg 2001; 108: 1972-1980 , discussion 1981
  MissingFormLabel

  PubMedSearch in Google Scholar