Resurfacing of Lower Face Scars With a Pre-expanded Flap From the Neck

A 20-Year Experience with Tissue Expansion for Large Cervical Fascial Defects: An Algorithm Based on Different Clinical Flap Designs

Over the past 20 years, we have designed various types of expanded cervical flaps for large facial defects and achieved excellent tissue matching. This study was performed to propose a treatment strategy for flap selection for the reconstruction of different facial units. The authors retrospectively reviewed the application of cervical expanded flaps for facial rehabilitation in our department between January 2003 and January 2023. The study included 122 patients with unilateral (62.3%) and bilateral (37.7%) facial deformities ranging from the zygomatic arch to the chin. The median area of the tissue defect was 15.2 × 8.5 cm2 (ranging from 6 × 4 cm2 to 27 × 12 cm2). The expansion period ranged from 61 to 175 days (mean: 86.5 days). Maximum and minimum sizes of pre-expanded cervical flaps were 30 × 13 cm2 to 7 × 5 cm2. All the flaps could be summarized into type 1, an advanced expanded cervical flap; type 2, a wing-shaped expanded cervical flap with overlapping tissue expansion; and type 3, an expanded single-lobed transposition flap rotated based on the anterior neck. Cervical flaps reliably meet the reconstructive requirements for different facial units, especially for large cutaneous defects in the clinic. The selection of these flaps can be planned preoperatively according to the location and size of the defect or lesion.

Surgical Treatment for Extensive Postburn Facial Deformity Using Tube Flap and Cervicofacial Flap

The current concept of facial unit reconstruction has evolved from simple coverage of defects to the reconstruction of the 3-dimensional structure and delicate features. The reshaping of the middle third of the face, including the nose and cheek, remains a challenge for plastic surgeons due to its complex structure and the dynamic relationship between each part. In this article, the authors describe a clinical report of extensive facial burns with skin lesions in the middle third of the face. The 30-year-old female patient sustained burns throughout the full thickness of the skin burns on the entire nose and left cheek with hypertrophic scar. The authors performed an expanded cervical-facial flap and tube flap of the upper extremity to reconstruct the entire nasal and cheek region. The patient underwent 8 stages of the operation successively resulting in a satisfactory level of appearance and function.

Using an Expanded Cervical Flap With an Overlapping Tissue Expansion Technique to Resurface Middle and Lower Facial Defects

BACKGROUND

Extensive facial burn scars are a tragedy for patients and often pose a great challenge to surgeons because of the high esthetic and functional demands. For patients with healthy skin in the neck region, a cervical flap is highly recommended for facial resurfacing; however, the skin on the midline of the neck often needs more expansion than that on either side, especially for the treatment of large facial defects. The sufficient longitudinal soft tissue in the anterior neck ensures a normal neck shape as well as a normal range of cervical extension, rotation, and lateral flexion. To overcome this, we developed an expanded cervical flap with an overlapping tissue expansion technique to gain more length centrally.

METHODS

First, 2 tissue expanders were embedded in the anterior neck region overlapping each other at the midline of the neck. After adequate inflation of the expander, the expanded flap was dissected and rotated to repair defects in the middle and lower face. The anchor position of the flap was placed on the horizontal line of the thyroid cartilage to restore the cervicomental angle.

RESULTS

Sixteen patients were treated with this method in this single-center study. All defects affected the middle and lower face, with an area ranging from 135 to 185 cm 2 , and were caused by a massive facial burn. Among them, 12 patients suffered ectropion of the lower lip, 3 suffered limited mouth opening due to scar contraction, and one patient had a cervicomental adhesion. The area of the expanded flap was approximately 163 to 266 cm 2 . The average period of expansion was 89.5 days. Patients were followed up after the operation, with the follow-up period ranging from 6 to 12 months. In all cases, good defect coverage was achieved, with primary closure of the donor sites and a good postoperative cervical configuration.

CONCLUSION

We conclude that the expanded cervical flap with the overlapping tissue expansion technique proved to be a reliable method for facial skin reconstruction with functional and aesthetic improvement.

Reconstruction of Large Cervicofacial Defects With Expanded Island Superficial Temporal Artery Flaps and an 810-nm Diode Laser Hair Removal Technique

BACKGROUND

Extensive cervicofacial reconstruction is challenging for plastic surgeons. Because of the location of the adjacent scalp flap nourished by the superficial temporal artery (STA), it can be a candidate for cervicofacial reconstruction.

OBJECTIVES

This article aims to report a combined treatment of an expanded island STA flap and an 810-nm diode laser hair removal technique for extensive cervicofacial defects.

METHODS

Between January 2015 and December 2018, 10 patients with lower face and neck scar contraction were reconstructed with a bilateral or unilateral expanded STA island flap and an 810-nm diode laser for hair removal in this retrospective study. Hair removal via the 810-nm laser was started when the injected volume reached the volume of the expander, with a fluence of 35 to 40 J/cm2 and a 1 to 2 Hz repetition rate. Before second-stage surgery, the hair reduction rate was assessed. Twelve months after surgery, the degree of epilation efficacy according to the satisfaction scale and Global Aesthetic Improvement Scale was evaluated.

RESULTS

This study included 2 single-pedicle flaps and 8 double-pedicle flaps. The average size of the implanted expanders was 600 mL. The average injected volume was 1405 mL. Before second surgery, there was a 67.4% hair reduction rate. Twelve months after surgery, the results of Global Aesthetic Improvement Scale were very good (3), good (6), average (1), and poor (0).

CONCLUSIONS

The expanded island STA flap and 810-nm diode laser technique may be a novel treatment option for severe face and neck aesthetic reconstruction.

An algorithm for using expanded cervical flaps to resurface facial defects based on five different methods

BACKGROUND

For patients with healthy skin in the cervical region, the expanded cervical flap method is highly recommended for resurfacing facial skin defects. Many methods exist that use an expanded cervical flap. However, a gold standard for selecting the appropriate method for each patient is lacking. Here, we introduce 5 basic principles for how to use an expanded cervical flap and an algorithm for selecting the appropriate method.

METHODS

The authors reviewed the medical records for all patients treated with an expanded cervical flap to restore a facial skin lesion in Shanghai's Ninth People's Hospital between 2010 and 2015.

RESULTS

We summarized the 5 techniques according to different types of facial deformities: (1) an advancement of the expanded cervical flap; (2) an expanded cervical flap that is rotated toward the temporal side (the rotation pivot is located in the angle of the mandible); (3) an expanded cervical flap that is rotated toward the nasal side (the rotation pivot is located in the mentum; (4) an expanded cervical flap that is rotated cephalically along the midline toward the lower third of the face (the rotation pivot is located in the bilateral angle of the mandible); and (5) a prefabricated cervical flap that is used with superficial temporal vessels.

CONCLUSION

By using this algorithm and following five basic principles, all facial defects except for those on the nose and forehead can be resurfaced using an expanded cervical skin flap.

Repair lower face defect with an expanded flap from submental and submandibular region in children

Scar and defect in the lower face always lead to serious facial deformity and asymmetry. Conventional method such as skin graft or free flap is hard to obtain a satisfactory outcome. In this article, we present a skin expanding technique. An expanded flap was designed to repair the lower face scar or defect on submental and submandibular regions. A tissue expander was implanted into the region and inflated for 2 to 3 months. After removing the expander, we harvested the flap as a rotation flap to repair the lower facial defect. The longest follow-up period was 3 years. All of the flaps were well matched to the surrounding skin with respect to color, texture, and thickness. An expanded flap on submental and submandibular regions is suitable to repair a lower face defect.

[Cheek reconstruction]

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.

Global contributions to Annals of Plastic Surgery: authorship in an English language journal by international colleagues

We reviewed the contributor demographics of recent volumes of Annals of Plastic Surgery to quantify the contributions of authors from countries where the primary language is not English. For 2 volumes of Annals (63 and 65), such authors contributed 57% of the total articles published. Within the new section format of volume 66, authors from non-English language countries accounted for 60% of all original articles with substantial and often dominant representation in all sections. This survey shows that Annals publishes articles from an international population of contributors with effective inclusion of authors from countries with primary languages other than English.