Combined Flaps for Reconstructing Wide-Range Facial Defects

Abstract

This report aims to describe the technique of using combined flaps for reconstruction of wide-range facial defects. Two or more flaps were combined to repair wide-range facial wounds, complying with the principle of facial aesthetic subunits to maintain the inherent structural characteristics of the face, to design incision lines conforming to the natural facial contour lines (e.g., nasolabial fold, sulcus alaris, nasomaxillary suture, palpebral margin, vermilion border, hairline) or wrinkles, and to leave hidden incision lines if possible. There were 18 cases with excessively large facial defects requiring the use of a graft with local flaps. From April 1996 to May 2008, 124 patients had their wide-range facial defects repaired by combined flaps. The size of the defects ranged in size from 2.5×4 to 9×10cm. The healing for all the patients was uneventful, and the flap survived completely without complications. After an average of 6months (range, 1-48months), 87 of the patients were available for follow-up evaluation. There was no recurrence of tumor. The repaired tissues were well matched with surrounding tissue in color, texture, and contour. Incision lines were sheltered, and there were no anatomic deformities of the eyelid, upper lip, or nasal ala. Based on the facial aesthetic subregion principle, combined flaps were used to reconstruct wide-range facial defects effectively, obtaining good color, contour, and texture match with the surrounding skin. All in all, the cosmetic results were satisfactory.