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Han Y, Chen Y, Cui L, Chai M, Guo L, Tao R, Chen L, Han M, Han Y. One stage reconstruction of mid-face fistulous defects after maxillary sinus carcinoma resection with chimeric perforator free flaps. Microsurgery 2023; 43:476-482. [PMID: 36530044 DOI: 10.1002/micr.30996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 11/12/2022] [Accepted: 12/09/2022] [Indexed: 07/20/2023]
Abstract
BACKGROUND The reconstruction of large fistulous defects following the radical ablation of maxillary sinus carcinoma remains challenging. The procedure requires not only the coverage of both intra-nasal lining and cheek skin but also sufficient obliteration of dead space between the two surfaces. In this report, we present our experience on the reconstruction of through-and-through defects in the mid-face with poly-foliated chimeric perforator flaps. METHODS Nine patients (five males and four females) who received a two-skin paddled and one muscle segment chimeric perforator flap reconstruction after maxillary sinus carcinoma ablation between March 2015 and December 2019 were retrospectively reviewed in authors' hospital. The mean age of the patients was 59.11. Six patients were diagnosed as squamous cell carcinoma, two as adenoid cystic carcinoma, and one as adenocarcinoma. Brown class IIIa defects were found in eight patients, and one patient had a Brown class IVa defect. The mean size of intra-nasal defect was 5.67 × 4.06 cm2 , and the mean size of facial skin defect was 8.94 × 6.56 cm2 . ALT flaps were used in five patients, LD flaps in four patients. The minor skin paddle was firstly inset to the mucosal defect site as the lining. Then, the muscle segment was inset to eliminate the dead cavity. Finally, the major skin paddle was inset to recover the cutaneous defect. RESULTS In ALT group, the mean size of the minor skin paddle was 5.7 × 4.7 cm2 , and the mean size of the major skin paddle was 8.7 × 6.6 cm2 . In LD group, the mean size of the minor skin paddle was 6.88 × 4.38 cm2 , and the mean size of the major skin paddle was 11 × 7.75 cm2 .All donor sites were closed primarily. All flaps survived and no partial flap loss was encountered. The mean follow-up time was 14.67 months, and there were no major postoperative complications. CONCLUSION The use of poly-foliated chimeric perforator free flaps can provide functional and aesthetic coverage for extensive through-and-through mid-face defects without significant donor-site morbidities.
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Affiliation(s)
- Yudi Han
- Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Youbai Chen
- Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Lei Cui
- Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Mi Chai
- Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Lingli Guo
- Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Ran Tao
- Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Lei Chen
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Mingkun Han
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Yan Han
- Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
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Gong Z, Zhang S, Li P, Liu J, Xu Y. Femoral artery-nourished anteromedial thigh flap: A new perspective in oral and maxillofacial defect reconstruction. Oral Oncol 2021; 117:105295. [PMID: 33887634 DOI: 10.1016/j.oraloncology.2021.105295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/05/2021] [Accepted: 04/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the feasibility and efficacy of the femoral artery (FA)-nourished anteromedial thigh (AMT) flap for reconstructing oral and maxillofacial defects. PATIENTS AND METHODS The authors analyzed a retrospective case series of 13 patients who underwent the reconstruction of oral and maxillofacial defects with the FA-nourished AMT flap. The flap design and the methods for defect reconstruction are described, and the reconstructive efficacy is reported. RESULTS Of the 13 patients, 12 were men, and 1 was woman, with an average age of 52.2 years. Of these FA-supplied AMT flaps, 7 were singly used, 5 were combined with the anterolateral thigh (ALT) flap or its chimeric flaps, and 1 was separately used with the ALT flap. Postoperatively, all flaps survived completely, without vascular compromise or major wound complications. CONCLUSIONS The FA-nourished AMT flap can also be used to reconstruct some common oral and maxillofacial defects, especially as a new alternative to the ALT flap. In addition, this flap can be combined with the ALT flap or its chimeric flaps or separately used with the ALT flap for the reconstruction of complex defects.
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Affiliation(s)
- Zhaojian Gong
- Department of Stomatology, the Second Xiangya Hospital, Central South University, Changsha 410011, China.
| | - Shanshan Zhang
- Department of Stomatology, Xiangya Hospital, Central South University, Changsha 410008, China.
| | - Panchun Li
- Department of Stomatology, the Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Jiang Liu
- Department of Stomatology, the Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Yuming Xu
- Department of Stomatology, the Second Xiangya Hospital, Central South University, Changsha 410011, China
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Qing L, Wu P, Zhou Z, Yu F, Tang J. Customized reconstruction of complex three-dimensional defects in the extremities with individual design of vastus lateralis muscle-chimeric multi-lobed anterolateral thigh perforator flap. J Plast Surg Hand Surg 2019; 53:271-278. [PMID: 31032709 DOI: 10.1080/2000656x.2019.1606004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The anterolateral thigh perforator (ALTP) chimeric flap is one of the most popular procedures for the reconstruction of three-dimensional defects in the extremities. However, the problems of donor-site morbidity and inability to repair very large defects in a one-stage procedure remain. The purpose of this study was to present a novel design of ALTP chimeric flap and its various designs for customized reconstruction of complex three-dimensional defects in the extremities. From January 2009 to June 2017, we retrospectively analyzed 25 patients with complex three-dimensional defects in the extremities. All patients in this series underwent extremity reconstruction using vastus lateralis (VL) muscle-chimeric multi-lobed ALTP flaps, consisting of multi-lobed skin paddles and muscle segment on the same pedicle from the descending branch of the lateral circumflex femoral artery. Three different types of VL muscle-chimeric multi-lobed ALTP flaps were created in this study. The sizes of the multi-lobed skin paddles range from 10 × 6 cm and 9 × 7 cm to 19 × 9 cm and 20 × 9 cm, and the sizes of muscle segments ranged from 9 × 6 cm to 4 × 4 cm. All of the flaps survived. Only one case required re-exploration because of venous congestion. The primary closure of the donor site was successfully achieved in all patients. The mean follow-up time was 14 months. Most of the cases showed satisfactory contour. The VL muscle-chimeric multi-lobed ALTP flap is a reliable option for reconstruction of complex three-dimensional defects of the extremities. It provided flexible design for customized coverage of complex three-dimensional defects with limited donor-site morbidity.
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Affiliation(s)
- Liming Qing
- Department of Hand & Microsurgery, Xiangya Hospital of Central South University , Changsha , China
| | - Panfeng Wu
- Department of Hand & Microsurgery, Xiangya Hospital of Central South University , Changsha , China
| | - Zhengbing Zhou
- Department of Hand & Microsurgery, Xiangya Hospital of Central South University , Changsha , China
| | - Fang Yu
- Department of Hand & Microsurgery, Xiangya Hospital of Central South University , Changsha , China
| | - Juyu Tang
- Department of Hand & Microsurgery, Xiangya Hospital of Central South University , Changsha , China
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Makiguchi T, Yokoo S, Ogawa M. Standard morphology of the oral commissure and changes resulting from reconstruction for defects involving the commissure. Int J Oral Maxillofac Surg 2018; 47:1274-1280. [PMID: 29402515 DOI: 10.1016/j.ijom.2018.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 11/27/2017] [Accepted: 01/15/2018] [Indexed: 12/01/2022]
Abstract
The aim of this study was to characterize the standard morphology of the oral commissure and to describe the changes after reconstruction in patients with through-and-through cheek defects involving the oral commissure. Indices for the morphological analyses of the commissure were derived from examinations of 50 normal Japanese volunteers. Ten patients with full-thickness cheek defects involving the commissure were then evaluated. All of these patients underwent free flap reconstruction with vermilion advancement flaps from the remaining vermilion. The morphology of the commissure with the mouth closed was classified based on the point of entrance of the vermilion into the oral cavity. In normal volunteers, the commissure pattern consisting of the entrance of the upper vermilion into the oral cavity before the lower vermilion and just prior to forming the oral commissure was considered to be the standard. However, in the reconstructed cases, there was an increase in the pattern in which the lower vermilion enters the oral cavity before the upper vermilion for the remaining commissure postoperatively, especially when the lower lip defects were greater than those of the upper lip. It is important to refer not only to the standard morphology of the commissure, but also to the changes according to the extent of resection and the method of reconstruction.
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Affiliation(s)
- T Makiguchi
- Department of Oral and Maxillofacial Surgery, Gunma University Graduate School of Medicine, Gunma, Japan.
| | - S Yokoo
- Department of Oral and Maxillofacial Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - M Ogawa
- Department of Oral and Maxillofacial Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
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Massarelli O, Vaira LA, Gobbi R, Dell'aversana Orabona G, De Riu G. Reconstruction of full-thickness cheek defect with chimeric facial artery free flap: A case report. Microsurgery 2017; 38:427-431. [PMID: 29218849 DOI: 10.1002/micr.30282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 11/08/2017] [Accepted: 11/29/2017] [Indexed: 11/07/2022]
Abstract
Full-thickness cheek defects represent a difficult challenge for reconstructive surgeons. Multiple techniques have been described, including local, regional, and free flaps. In this report, the reconstruction of a through and through left cheek defect, resulting from a self-inflicted gunshot injury, with a chimeric facial artery free flap is presented. The patient underwent reconstruction with a chimeric full-thickness facial artery free flap, with 9 × 3 cm diameter skin paddle and a 6 × 5 cm myomucosal paddle, was harvested on the contralateral cheek with a 7-cm length of facial pedicle. The flap was transferred via a microsurgical technique and an end-to-end microsurgical anastomosis was performed between the donor and the contralateral facial vessels. The flap was transplanted successfully and there were no donor or recipient site complications with a satisfactory esthetic result 5 years after surgery. This technique may be a good reconstructive option for medium size, full-thickness, cheek defects allowing a "like with like" reconstruction with minimal donor-site morbidity.
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Affiliation(s)
- Olindo Massarelli
- Maxillofacial Surgery Unit, University Hospital of Sassari, Viale San Pietro 43/B, Sassari, 07100, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Unit, University Hospital of Sassari, Viale San Pietro 43/B, Sassari, 07100, Italy
| | - Roberta Gobbi
- Maxillofacial Surgery Unit, University Hospital of Sassari, Viale San Pietro 43/B, Sassari, 07100, Italy
| | | | - Giacomo De Riu
- Maxillofacial Surgery Unit, University Hospital of Sassari, Viale San Pietro 43/B, Sassari, 07100, Italy
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Gong ZJ, Ren ZH, Wang K, Tan HY, Zhang S, Wu HJ. Reconstruction design before tumour resection: A new concept of through-and-through cheek defect reconstruction. Oral Oncol 2017; 74:123-129. [DOI: 10.1016/j.oraloncology.2017.09.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/29/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
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Liu F, Wang L, Pang S, Kan Q. Reconstruction of full-thickness buccal defects with folded radial forearm flaps: A retrospective clinical study. Medicine (Baltimore) 2017; 96:e7344. [PMID: 28796029 PMCID: PMC5556195 DOI: 10.1097/md.0000000000007344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Our goal was to describe our experience of the folded radial forearm flap (RFF) flap in through-and-through buccal defect reconstructions.Patients who had received a folded RFF flap for full-thickness cheek defect reconstruction were included. The flap success rate and functional results were evaluated.Six patients were enrolled. All flaps survived totally without any complication; the mean flap size was 75.5 (range 32-135) cm. The mean mouth-open width was 4.2 (range 3.5-4.7) cm at 6 months after operation. All patients were satisfied with the appearance and were capable of maintaining a regular oral diet, and no patients complained of an inability to eat in a public setting, microstomia, or drooling.Radial forearm flap was a reliable method for through-and-through buccal reconstruction with high success rate and good functional result.
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Affiliation(s)
- Fei Liu
- Department of Stomatology, the First Affiliated Hospital of zhengzhou University, Zhengzhou
| | - Lei Wang
- Department of Stomatology, School of Stomatology, Xinxiang Medical Collage, Xinxiang
| | - Shuang Pang
- Department of Stomatology, Nanyang Stomatology Hospital, Nanyang
| | - Quancheng Kan
- Department of Gastroenterology, the First Affiliated Hospital of zhengzhou University, Zhengzhou, PR China
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Experience With the Use of Free Fasciocutaneous Flap in Through-and-Through Cheek-Buccal Defect Reconstruction. Ann Plast Surg 2016; 76 Suppl 1:S74-9. [DOI: 10.1097/sap.0000000000000692] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Li P, Fang QG, Luo RH, Zhao M, Liu ST, Du W, Qi J. Reconstruction of full-thickness buccal defects with submental island flap. J Craniofac Surg 2016; 26:e104-6. [PMID: 25759929 DOI: 10.1097/scs.0000000000001281] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Our goal was to introduce the application of submental island flap in reconstructing through-and-through cheek defects. From January 2009 to January 2013, 7 patients (5 men and 2 women) with full-thickness buccal defects due to tumor resection received submental flap reconstruction at the Affiliated Tumor Hospital of Zhengzhou University; surgical procedure and success rate as well as functional results were described. Distal partial necrosis occurred in 1 flap, but all flaps survived. All patients were capable of maintaining a regular oral diet, and no patients complained of an inability to eat in a public setting, microstomia, or drooling; the appearance was reported to be good or acceptable in all cases, and the mean postoperative mouth-open width was 4.2 (range, 3.7-5.0) cm. One patient had a local recurrence in the follow-up. Therefore, submental island flap is a reliable procedure for through-and-through buccal defects in selected patients.
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Affiliation(s)
- Peng Li
- From the Department of Head Neck & Thyroid Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
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Gong ZJ, Wang K, Tan HY, Zhang S, He ZJ, Wu HJ. Application of Thinned Anterolateral Thigh Flap for the Reconstruction of Head and Neck Defects. J Oral Maxillofac Surg 2015; 73:1410-9. [DOI: 10.1016/j.joms.2015.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 01/05/2015] [Accepted: 01/05/2015] [Indexed: 10/24/2022]
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Gong ZJ, Zhang S, Wang K, Tan HY, Zhu ZF, Liu JB, Ren ZH, He ZJ, Wu HJ. Chimeric flaps pedicled with the lateral circumflex femoral artery for individualised reconstruction of through-and-through oral and maxillofacial defects. Br J Oral Maxillofac Surg 2015; 53:148-52. [DOI: 10.1016/j.bjoms.2014.10.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 10/29/2014] [Indexed: 10/24/2022]
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Wang WH, Deng JY, Xu B, Zhu J, Xia B, Zhang BJ. Double anterior (anterolateral and anteromedial) thigh flap for oral perforated defect reconstruction. J Craniomaxillofac Surg 2014; 42:2041-4. [PMID: 25458346 DOI: 10.1016/j.jcms.2014.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 08/19/2014] [Accepted: 09/25/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess the therapeutic efficacy of oral perforated defect reconstruction with a double anterior (anterolateral and anteromedial) thigh flap through the modified lateral lip-submandibular approach. MATERIALS AND METHODS From July 2010 to August 2013, eight patients with oral perforated defects secondary to oral cancer ablation involving the superior partial mandible or the posterior partial maxilla, with immediate reconstruction by double anterior (anterolateral and anteromedial) thigh flaps, were retrospectively enrolled into this study. RESULTS All double anterior flaps were musculocutaneous flaps. Seven double flaps resulted in good functional and aesthetic outcomes with complete flap survival. One patient required operative exploration in the postoperative period due to thrombosis in the external jugular vein. After the salvage, one of the double flaps in the intraoral region resulted in partial failure of the superficial skin of the flap. No functional impairment at the donor sites occurred in any of the cases. CONCLUSION The double anterior (anterolateral and anteromedial) thigh flap is a feasible and acceptable technique for reconstruction of an oral perforated defect involving the mandible or the maxilla through the modified lateral lip-submandibular approach. It presents a very acceptable aesthetic and functional result with the additional advantage of low morbidity at the donor site.
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Affiliation(s)
- W H Wang
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Kunming Medical University, Kunming 650031, China.
| | - J Y Deng
- Department of Computer Tomography, Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - B Xu
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Kunming Medical University, Kunming 650031, China
| | - J Zhu
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Kunming Medical University, Kunming 650031, China
| | - B Xia
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Kunming Medical University, Kunming 650031, China
| | - B J Zhang
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Kunming Medical University, Kunming 650031, China
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Gong ZJ, Zhang S, Ren ZH, Zhu ZF, Liu JB, Wu HJ. Application of Anteromedial Thigh Flap for the Reconstruction of Oral and Maxillofacial Defects. J Oral Maxillofac Surg 2014; 72:1212-25. [DOI: 10.1016/j.joms.2013.11.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 11/09/2013] [Accepted: 11/11/2013] [Indexed: 11/16/2022]
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Huguier V, Dagrégorio G, Darsonval V, Arnaud D, Potier B, Rousseau P. [Cheek reconstruction]. ANN CHIR PLAST ESTH 2013; 58:457-514. [PMID: 24125779 DOI: 10.1016/j.anplas.2013.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 07/03/2013] [Indexed: 11/29/2022]
Abstract
We describe the different cheek reconstruction techniques with primary emphasis on the superficial layers. In addition to the clinical context, location and size of the lesion will be taken into account to choose the best method that will optimize the functional and aesthetic results while minimizing potential sequelae. Main evaluation criteria include absence of natural orifice deformation, scar location, skin cover quality and respect of volumes.
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Affiliation(s)
- V Huguier
- Service de chirurgie plastique, CHU, 2, rue de la Milétrie, 86021 Poitiers cedex, France.
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