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Shim HS, Ryoo HJ, Choi JS, Park JA, Kim YH. Principles and Clinical Application of Free-Style Capillary Perforator-Based Flap for Coverage of Facial Skin Cancer Defects. Cancers (Basel) 2024; 16:2206. [PMID: 38927912 PMCID: PMC11201941 DOI: 10.3390/cancers16122206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
This study introduces a free-style perforator based island flap (PBIF) for the reconstruction of skin defects. From March 2012 to December 2022, a retrospective investigation was conducted on patients who underwent reconstruction for facial defects due to skin cancer. Data on the patients' gender, age, anesthesia method, diagnosis, defect location, flap size, complications, and follow-up periods were collected. There are several principles for designing the PBIF: finger-pinching method, alignment with the direction of wrinkles, the smaller width and longer length of the flap, and proximal attachment to the muscle. A total of 32 patients were included, with an average age of 63.6 years. Surgeries were performed in various regions, such as the infraorbital area, nose, cheek, philtrum, and the anterior/posterior/inferior auricular regions, with an average flap size of 7.63 cm2. There were no complications, such as venous congestion or vascular insufficiency in the skin flaps, although one case required revisional closure due to flap disruption. The PBIF is a useful and effective method for the restoration of facial defects. This method can provide simple yet aesthetically satisfying results, showing stable outcomes without complex surgeries or complications. This study indicates the potential for this method to be more widely employed in reconstructive surgeries in the future.
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Affiliation(s)
- Hyung-Sup Shim
- Department of Plastic and Reconstructive Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (H.-J.R.); (J.-S.C.)
| | - Hyun-Jung Ryoo
- Department of Plastic and Reconstructive Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (H.-J.R.); (J.-S.C.)
| | - Jae-Seon Choi
- Department of Plastic and Reconstructive Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (H.-J.R.); (J.-S.C.)
| | - Ji-Ah Park
- Design Lab of Technology Commercialization Center, Industry-University Cooperation Foundation of Hanyang University, Seoul 04763, Republic of Korea;
| | - Youn-Hwan Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
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Salzano G, Maffìa F, Vaira LA, Committeri U, Copelli C, Maglitto F, Manfuso A, Abbate V, Bonavolontà P, Scarpa A, Califano L, Dell'Aversana Orabona G. Locoregional Flaps for the Reconstruction of Midface Skin Defects: A Collection of Key Surgical Techniques. J Clin Med 2023; 12:jcm12113700. [PMID: 37297895 DOI: 10.3390/jcm12113700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/17/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The reconstruction of midface skin defects represents a challenge for the head and neck surgeon due to the midface's significant role in defining important facial traits. Due to the high complexity of the midface region, there is no possibility to use one definitive flap for all purposes. For moderate defects, the most common reconstructive techniques are represented by regional flaps. These flaps can be defined as donor tissue with a pedunculated axial blood supply not necessarily adjacent to the defect. The aim of this study is to highlight the more common surgical techniques adopted for midface reconstruction, providing a focus on each technique with its description and indications. METHODS A literature review was conducted using PubMed, an international database. The target of the research was to collect at least 10 different surgical techniques. RESULTS Twelve different techniques were selected and cataloged. The flaps included were the bilobed flap, rhomboid flap, facial-artery-based flaps (nasolabial flap, island composite nasal flap, retroangular flap), cervicofacial flap, paramedian forehead flap, frontal hairline island flap, keystone flap, Karapandzic flap, Abbè flap, and Mustardè flap. CONCLUSIONS The study of the facial subunits, the location and size of the defect, the choice of the appropriate flap, and respect for the vascular pedicles are the key elements for optimal outcomes.
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Affiliation(s)
- Giovanni Salzano
- Maxillofacial Surgery Operative Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy
| | - Francesco Maffìa
- Maxillofacial Surgery Operative Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
- Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, 07100 Sassari, Italy
| | - Umberto Committeri
- Maxillofacial Surgery Operative Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy
| | - Chiara Copelli
- Maxillofacial Surgery Operative Unit, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, 70120 Bari, Italy
| | - Fabio Maglitto
- Maxillofacial Surgery Operative Unit, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, 70120 Bari, Italy
| | - Alfonso Manfuso
- Maxillofacial Surgery Operative Unit, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, 70120 Bari, Italy
| | - Vincenzo Abbate
- Maxillofacial Surgery Operative Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy
| | - Paola Bonavolontà
- Maxillofacial Surgery Operative Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy
| | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, 84081 Salerno, Italy
| | - Luigi Califano
- Maxillofacial Surgery Operative Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy
| | - Giovanni Dell'Aversana Orabona
- Maxillofacial Surgery Operative Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy
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CAN B, EKİNCİ C. Algorithms for perforator-based flaps in different anatomical locations. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1120364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Perforator-based flaps can be planned in any anatomic location in the body when there is a detectable perforator. Although preoperative perforator mapping ensures safety and versatility of these flaps, there is no consensus yet about flap planning in different anatomical locations.
Material and Method: 28 patients underwent perforator-based flap surgery for different anatomical locations as face (5), sternum (3), back (5), lomber (4), sacral (4) and scrotal (4) areas, leg (2) and foot (1). 19 of the patients were male while 9 were female. The mean age was 58.1±13.5 (22-80 years).
Perforator-based flaps were planned as V-Y design in face, sacral and scrotal areas while as perforator plus transposition flaps for lomber area, leg and sternum. On the other hand, for foot the flap was planned as subcutaneous-pedicled turnover flap.
Results: The mean follow-up time was 10 months (3-36 months). Partial flap necrosis is seen in all 3 patients who had underwent flap surgery on the lower extremity. There were no other complications seen in short- or long-term follow-ups. Comorbid diseases were not statistically significant on complications rates (P>0.05).
Conclusion: V-Y flap for the face and the sacral area; and perforator plus transposition flap for back ,lomber area and sternum are suggested as the ideal flap modifications for these anatomical locations. On the other hand, perforator-based flaps should not be used as a first choice in reconstruction of lower extremity defects.
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Affiliation(s)
| | - Can EKİNCİ
- ESKISEHIR OSMANGAZI UNIVERSITY, SCHOOL OF MEDICINE
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Cha HG, Kang MK, Kim W, Lee JS, Hong JP, Suh HP. Oncologic safety of propeller flap and free flap in reconstruction after soft tissue sarcoma resection. J Surg Oncol 2020; 122:787-794. [PMID: 32596810 DOI: 10.1002/jso.26076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/20/2020] [Accepted: 06/08/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES The propeller flap is a reliable option for reconstruction after soft tissue sarcoma resection. However, some parts of the resection margin may move away from its original position during flap rotation and thus can be excluded from the clinical target volume of adjuvant radiotherapy. This study aimed to evaluate local recurrence after soft tissue sarcoma resection with propeller flap or free flap reconstruction. METHODS Patients who underwent resection of soft tissue sarcoma followed by a free flap or propeller flap reconstruction and adjuvant radiotherapy at a single institution were retrospectively reviewed. RESULTS The 1- and 3-year local control rates were 94.6% and 88.6% in the free flap group vs 90.6% and 87.5% in the propeller flap group, without statistical significance. There were no statistically significant differences in 5-year local recurrence-free survival (88.6% vs 87.5%) and disease-free survival (82.5% vs 74.8%) between the groups. CONCLUSIONS Although there was no significant difference in local control and disease-free survival rates between propeller flap and free flap reconstruction after soft tissue sarcoma resection, a multidisciplinary approach is needed to obtain surgical information for determining the accurate clinical target volume of adjuvant radiotherapy and the area for meticulous follow-up postoperatively.
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Affiliation(s)
- Han Gyu Cha
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Korea
| | - Min Kyu Kang
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wanlim Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Seok Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Pio Hong
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyunsuk Peter Suh
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Liao ZF, Hong WJ, Cong LY, Luo CE, Zhan WF, Ke JQ, Luo SK. A case series: 3-dimensional computed tomographic study of the superior orbital vessels: Superior orbital arcades and their relationships with the supratrochlear artery and supraorbital artery. J Am Acad Dermatol 2020; 84:1364-1370. [PMID: 32592875 DOI: 10.1016/j.jaad.2020.06.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vascular complications from periorbital intravascular filler injection are major safety concerns. OBJECTIVE To thoroughly describe the superior orbital vessels near the orbital rim and propose considerations for upper eyelid and forehead injections. METHODS Fifty-one cadaver heads were infused with lead oxide contrast media through the external carotid artery, internal carotid artery, and facial and superficial temporal arteries. Computed tomography (CT) images were obtained after contrast agent injection, and 3-dimensional CT scans were reconstructed by using a validated algorithm. RESULTS Eighty-six qualified hemifaces clearly showed the origin, depth, and anastomoses of the superior orbital vessels, which consistently deployed 2 distinctive layers: deep and superficial. Of all hemifaces, 59.3% had deep superior orbital vessels near the orbital rim, including 44.2% with deep superior orbital arcades and 15.1% with deep superior orbital arteries, which originated from the ophthalmic artery. Additionally, 97.7% of the hemifaces had superficial superior orbital arcades, for which 4 origins were identified: ophthalmic artery, superior medial palpebral artery, angular artery, and anastomosis between the angular and ophthalmic arteries. LIMITATIONS The arterial depth estimated from 3-dimensional CT needs to be confirmed by standard cadaver dissection. CONCLUSION This study elucidated novel arterial systems and proposed considerations for upper eyelid and forehead injections.
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Affiliation(s)
- Zhi-Feng Liao
- Second School of Clinical Medicine, Southern Medical University, Guangzhou City, People's Republic of China; Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, People's Republic of China
| | - Wei-Jin Hong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, People's Republic of China
| | - Li-Yao Cong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, People's Republic of China
| | - Cheng-En Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, People's Republic of China
| | - Wen-Feng Zhan
- Department of Radiology, Guang Dong Second Provincial General Hospital, Guangzhou City, People's Republic of China
| | - Jia-Qia Ke
- Department of Neurology, Integrated Hospital of Traditional Chinese Medicine, The Third School of Clinical Medicine, Southern Medical University, Guangzhou City, People's Republic of China
| | - Sheng-Kang Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, People's Republic of China; Second School of Clinical Medicine, Southern Medical University, Guangzhou City, People's Republic of China.
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Hanick A, Ciolek P, Fritz M. Angular Vessels for Free‐Tissue Transfer in Head and Neck Reconstruction: Clinical Outcomes. Laryngoscope 2020; 130:2589-2592. [DOI: 10.1002/lary.28540] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 12/19/2019] [Accepted: 12/30/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Andrea Hanick
- Head and Neck Institute, Cleveland Clinic Foundation Cleveland Ohio
| | - Peter Ciolek
- Head and Neck Institute, Cleveland Clinic Foundation Cleveland Ohio
| | - Michael Fritz
- Section Head Facial Plastic and Microvascular Surgery, Head and Neck Institute, Cleveland Clinic Foundation Cleveland Ohio U.S.A
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Abstract
BACKGROUND Local flap surgery is commonly performed to cover defects with appropriate skin color and texture match. The purpose of this study was to present an algorithm for choosing an appropriate flap when reconstructing a midface defect using a local flap. METHODS Between February 2013 and February 2019, 38 patients with midface defects underwent local flap surgery. All defects larger than 3 cm in diameter were reconstructed with perforator-based transposition flaps. Defects smaller than 3 cm in diameter were reconstructed differently depending on their location. Defects near the nasolabial fold (NLF) were reconstructed with perforator-based transposition flaps, whereas defects just on the NLF were reconstructed with VY advancement flaps. Defects distant from the NLF were also reconstructed with VY advancement flaps. RESULTS Perforator-based transposition flaps were used in 22 cases and VY advancement flaps were used in 16 cases according to our new algorithm. All flaps survived without any complications. The aesthetic results were superior for VY advancement flaps, with higher patient satisfaction scores. The skin color match was similar for both flaps, but the contour was more natural in advancement flaps than in transposition flaps. However, transposition flaps had the benefits of being able to cover relatively large defects and allowing the donor scar to be hidden in a wrinkle line. CONCLUSION The most suitable local flap for coverage of a midface defect can be chosen based on the patient's condition. By following our algorithm, appropriate reconstructions can be performed, with satisfactory results.
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Lateral Nasal Artery Perforator Flaps: Anatomic Study and Clinical Applications. Arch Plast Surg 2016; 43:77-83. [PMID: 26848450 PMCID: PMC4738133 DOI: 10.5999/aps.2016.43.1.77] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/27/2015] [Accepted: 11/24/2015] [Indexed: 11/08/2022] Open
Abstract
Background Previous studies have investigated facial artery perforators, but have reported inconsistent results regarding lateral nasal artery (LNA) perforators. Although several authors have described the use of LNA perforators for ala nasi and nasal sidewall reconstruction, the literature contains little information regarding the cadaveric dissection of LNA perforators, and most previously published studies have focused on facial artery perforators. Methods Sixteen hemifaces from eight fresh cadavers were dissected to study the LNA perforators. After the dissection was performed, the total length and diameter of the LNA and its perforators were measured. The quantity and the distribution of the LNA perforators supplying the overlying skin were then assessed. LNA perforator flaps were used for reconstruction in 10 nasal and perinasal defects. Results The mean total lengths of the LNA and its perforators were 49.37 mm and 16.06 mm, respectively. The mean diameters of the LNA and its perforators were 2.08 mm and 0.91 mm, respectively. Based on our findings, we mapped the face to indicate zones with a higher probability of finding perforators. No infection, hematoma, or complete flap necrosis were observed after the procedures. Conclusions Nasal reconstruction is a challenging procedure, and LNA propeller/V-Y perforator flaps are an excellent reconstructive option in certain cases. Based on our cadaveric study, we were able to identify an area in the upper third of the nasolabial groove with a high density of perforators.
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Facial Artery Perforator and Depressor Anguli Oris Muscle Chimeric Flap: A New Design of an Old Flap. Ann Plast Surg 2015. [PMID: 26207546 DOI: 10.1097/sap.0000000000000549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to investigate the reliability and outcomes of the facial artery perforator and separately elevated depressor anguli oris (DAO) muscle chimeric flap for the reconstruction of partial or total lower lip defects. METHODS Eleven patients with malignant skin tumors located at the lower lip were operated between 2013 and 2015. After the excision of the tumor with adequate clear margins using margin controlled excision technique, an appropriate flap fitting to the resultant defect based on the perforators of the facial artery and DAO muscle was prepared and placed into the defect. The DAO muscle activity was tested with electromyography in the postoperative first year examination. RESULTS Besides 1 patient with transient venous insufficiency, all the flaps healed well without a partial or total flap loss. The mean follow-up period was 10 months. No new primary tumor or recurrence was observed. Although in 1 patient, transient asymmetric smiling and mild drooling was observed, the overall oral competence results were found to be quite satisfactory. The electromyography evaluation of DAO muscle of 5 patients who reached the postoperative first year examination showed action potential results in normal limits with a slight decrease. All patients were satisfied with the final esthetic and functional result. CONCLUSIONS The facial artery perforator and depressor angel oris muscle chimeric flap is a valuable option for reconstruction of lower lip defects providing esthetically and functionally good results.
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Reconstruction of various perinasal defects using facial artery perforator-based nasolabial island flaps. Arch Plast Surg 2013; 40:754-60. [PMID: 24286050 PMCID: PMC3840184 DOI: 10.5999/aps.2013.40.6.754] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 07/15/2013] [Accepted: 07/26/2013] [Indexed: 11/28/2022] Open
Abstract
Background Classical flaps for perinasal defect reconstruction, such as forehead or nasolabial flaps, have some disadvantages involving limitations of the arc of rotation and two stages of surgery. However, a perforator-based flap is more versatile and allows freedom in flap design. We introduced our experience with reconstruction using a facial artery perforator-based propeller flap on the perinasal area. We describe the surgical differences between different defect subtypes. Methods Between December 2005 and August 2013, 10 patients underwent perinasal reconstruction in which a facial artery perforator-based flap was used. We divided the perinasal defects into types A and B, according to location. The operative results, including flap size, arc of rotation, complications, and characteristics of the perforator were evaluated by retrospective chart review and photographic evaluation. Results Eight patients were male and 2 patients were female. Their mean age was 61 years (range, 35-75 years). The size of the flap ranged from 1 cm×1.5 cm to 3 cm×6 cm. Eight patients healed uneventfully, but 2 patients presented with mild flap congestion. However, these 2 patients healed by conservative management without any additional surgery. All of the flaps survived completely with aesthetically pleasing results. Conclusions The facial artery perforator-based flap allowed for versatile customized flaps, and the donor site scar was concealed using the natural nasolabial fold.
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