Reconstruction Of Cheek Defects Research Articles

Use of a Titanium Microplate to Anchor Subunit Reconstruction at the Nasal-Cheek Junction.

Reconstruction of combined nose, cheek, and/or inferior eyelid defects is facilitated by stable anchorage at the nasal-cheek junction. The previously reported techniques of drill holes and Mitek anchors are not without disadvantages. The authors present a simple means of anchoring soft tissue flaps at the nasal-cheek junction: a titanium miniplate secured with a screw at each end. Our case report describes successful, lasting, and complication-free anchorage of cheek, forehead, and eyelid flaps to a single miniplate placed along the piriform aperture.

Reconstruction of full-thickness cheek defects with a folded extended supraclavicular fasciocutaneous island flap following ablation of advanced oral cancer.

The aim of the present clinical study was to evaluate the feasibility of a folded extended supraclavicular fasciocutaneous island flap (SFIF) for full-thickness cheek defect reconstruction following ablative oral cancer surgery. The nine patients with advanced squamous cell carcinoma of the buccal mucosa were six men and three women, with a mean age of 60.8 years. All patients were treated with surgery including ipsilateral radical neck dissection. A folded extended SFIF with a skin paddle ranging between 6 × (6 + 5) cm and 7 × (10 + 9) cm were used to reconstruct the full-thickness cheek defects. One minor flap failure and one wound dehiscence in donor site occurred, but all flaps survived, and there was no major complication in any patient. All patients were able to receive all of their nutrition orally and had normal speech. The patients were followed-up for 9-28 months; six patients were living with no evidence of disease, two was living with disease, and one died of local recurrence. The folded extended SFIF to reconstruct full-thickness cheek defects is reliable and an excellent alternative to other options for patients who have full-thickness defect of the cheek.

Pectoralis major myocutaneous island flap for reconstruction of head and neck defects

Background: Pectoralis major myocutaneous island flap for reconstruction has been used since many decades with success. There is need to evaluate the efficacy of pectoralis major myocutaneous island flap for reconstruction in head and neck surgeries. The objective of the study was to study reliability and usefulness of pectoralis major myocutaneous flap. Methods: This study was carried out for a period of two years at T. N. M. College and Nair Hospital, Mumbai. During this period 12 cases were treated and evaluated. Institutional ethics committee permission was taken. Individual patient consent was obtained. History and clinical examination was carried out as per the protocol. In all cases routine investigations as well as additional investigations as per the case were done. Pectoralis major myocutaneous island flap (PMMC) was used for primary and secondary procedures. Results: Age of patients ranged from 36-70 years. Majority of patients were between 51-70 years of age. In this study, males outnumbered females. The male to female ratio was 2:1. In the majority of cases, single paddle pectoralis major myocutaneous flap was used, whereas double paddle was used in only 2 cases. Donor site was sutured primarily in 8 cases. Split thickness skin grafting was done in 4 cases for donor site of D. P. flap. Superficial necrosis of skin Island was seen in one case. 50% of the patients did not have any complications. In five cases of cheek defect reconstruction, mouth opening was 2 finger breadths. There was no difficulty for swallowing of solids and liquids in 4 cases of pharyngocutaneous fistulae. Conclusions: Pectoralis major myocutaneous island flap for reconstruction of head and neck defects was found to be very effective. Post-operative complications were rare.

Developing an Algorithm for Reconstruction of Full Thickness Cheek Defect by Submental Flap

Developing an Algorithm for Reconstruction of Full Thickness Cheek Defect by Submental Flap

Cheek reconstruction following facial malignant melanoma surgery with the platysma myocutaneous flap

The aim of this study was to evaluate the results of large cheek skin defect reconstruction using a superiorly based platysma myocutaneous flap accompanied by facial artery and vein preservation, following cutaneous head and neck melanoma surgery. This study offers new insight into a procedure that is a viable, but infrequently used reconstruction option. The authors report the cases of 13 consecutive patients with cheek skin defects following melanoma surgery who underwent reconstruction with a superiorly based platysma myocutaneous flap. The procedures were performed at a tertiary clinical centre and a national melanoma surgery referral centre between 2001 and 2008. According to the disease stage, eight patients underwent sentinel lymph node biopsy and five underwent comprehensive neck dissections. All of the patients were monitored for any complications related to the donor and recipient sites. Minor venous congestion of the flap was noted in two patients, with minor marginal skin necrosis in one patient. None of the patients had donor site complications. The superiorly based platysma flap proved to be a safe and reliable option for large cheek defect reconstruction, especially considering that it is a single-stage reconstruction procedure ensuring excellent colour-matching and low donor site morbidity.

Reverse Superior Labial Artery Flap in Reconstruction of Nose and Medial Cheek Defects

Angular artery, lateral nasal artery, and infraorbital artery pedicled nasolabial flaps have been used for reconstruction of lower nose and medial cheek defects. An alternative pedicle to raise a flap in the nasolabial area is the superior labial artery. Superior labial artery is a constant branch of the facial artery, arising above or at the angle of mouth and anastomoses with its counterpart in the middle of the upper lip. This makes a reverse superior labial artery pedicle possible for elevation of a nasolabial flap. Reverse superior labial artery island flaps were used for reconstruction of lower nose and medial cheek defects in 12 patients. Eleven patients presented with malignant skin lesions and 1 with a traumatic defect of the lower nose. Auricular cartilage graft to support the alar rim and nasal tip was combined to the flap in 3 patients. All flaps survived completely. Temporary venous congestion was observed in 3 flaps in the early postoperative period but this resolved in 3 to 5 days. All patients healed without any postoperative complications and the final results were considered satisfactory. Reverse superior labial artery pedicled nasolabial island flap proved to be a good choice for reconstruction of the lower nose and moderate sized medial cheek defects. This pedicle should be considered where the defect is located on the course of lateral nasal artery or angular artery. Arc of rotation and reliability of this new flap is considered superior to angular artery and infraorbital artery-based nasolabial flaps where these arteries could also be used as pedicle.

Reconstruction of the zygomatic cheek defects using a flap based on the pretragal perforator of the superficial temporal artery

The aim of this study was to create a new flap based method for zygomatic cheek defect reconstruction using the pretragal perforator from the superficial temporal artery. Ten fresh cadavers were dissected after vascular injection to study pretragal perforator distribution, length, and diameter. Twelve clinical cases of zygomatic cheek defects were reconstructed using pretragal perforator flaps. According to the location of the perforator that was preoperatively probed using an ultrasound Doppler blood flow detector and the zygomatic cheek defect condition, size, and distance from the distal border to the tragus and the flabby surrounding skin, we designed a spindle-shaped longitudinal flap in the preauricular region based on the pretragus. The flap was raised superficially to the superficial musculoaponeurotic system from the caudal border incised primarily to the cephalic border to create the perforator flap. The flap was sutured to the defect and the donor site was closed. Cadaver dissection showed a quite constant perforator given off by the superficial temporal artery or its auricular branches with an appearance rate of 85% anterior to the tragus. The average perforator length was 18.3 mm (range, 11.2-24.2 mm). The average perforator diameter was 0.65 mm (range, 0.4-1.15 mm). A total of 12 clinical cases were available for 6-12 month postoperative follow-up. Favorable survival, primary closure, and esthetic results were achieved without any complications. Zygomatic cheek defect reconstruction using the above-mentioned flap can achieve satisfactory esthetic and functional results and boasts a simple design, convenient procedure, reliable blood supply, and concealed donor site incision.

A Novel Flap for the Reconstruction of Midcheek Defects

Cheek defects generally occur because of reasons such as trauma, burn, and tumor excisions. In the reconstruction of cheek defects, it is essential to cover the defects using the tissues with compatible color and similar texture. Although many techniques have been described for this purpose, local flaps are more likely to be used.In this study, we describe a new technique named "rabbit ear flap," which we used for the reconstruction of a 4.5 × 7-cm cheek defect due to basal cell carcinoma excision in a 71-year-old male patient. Two separate flaps on the extension of right facial artery with an inferior pedicle on the nasolabial region (hairless skin) and a superior pedicle flap that extended from right oral commissure to the submandibular region (hairy skin) were used. The hairy skin part of the defect was closed via the hairy skin flap, whereas the hairless region was closed with the hairless skin flap. The donor sites were closed primarily.No complication was encountered in the early or long-term follow-ups. In the 28-month follow-up of the patient, it was observed that the color and texture compatibility was fine, the natural beard integrity was obtained, the donor site scarring was minimal, and the scarring was camouflaged well in the anatomical lines.This technique is supposed to be an alternative method for reconstruction of medium-sized cheek defects because it is a simple, reliable, and single-session procedure, and because of its similar color and texture, it offers satisfactory aesthetic and functional outcomes due to natural beard restoration.

The faciocervicopectoral flap for non-oncological cases of cheek reconstruction

Major facial defect has been a challenging case for plastic surgeons in terms of wound healing and covering technique for a long time. Eight faciocervicopectoral (FCP) flaps were performed for reconstruction of major cheek defects due to handmade explosive and gun injuries. They were evaluated perioperatively and postoperatively with regard to operative time and operative blood loss as well as the function and cosmetic appearance. The technique showed marvellous cosmetic results but encountered minor postoperative flap complications. The FCP flap is one of the best solutions for coverage of a simple or complex cheek defect. Application of the FCP flap is easy and rapid.

Double-Skin Paddled Superficial Temporofascial Flap for the Reconstruction of Full-Thickness Cheek Defect

The most common causes of cheek defects include trauma, burn, and tumor resections. In the reconstruction of the defects in this region, it is essential to use similar or adjacent tissue considering the aesthetic and functional properties. For this purpose, numerous local, regional, or distant free flaps were described. The local flaps harvested from the head and neck region are the most frequent methods because of the similar skin color, texture, and compatibility with cheek.In this study, the reconstruction in a 29-year-old male patient who had a full-thickness cheek defect due to tumor resection on the left side was performed, wherein a hairless skin island was carried through the frontal branch of superficial temporal artery for oral mucosa, and a hairy skin island through the parietal branch of the same pedicle was carried for the bearded skin defect. No complication occurred postoperatively and both aesthetic and functional satisfactory results were obtained, providing the oral mucosal and natural beard integrity. Donor-site scarring and temporal alopecia were recorded as the disadvantages of this method.This technique is a useful method for the reconstruction of full-thickness cheek defects because of its advantages including compatibility of color and texture, reliable blood supply, requiring single-session procedure, and being able to carry 2 different skin islands on the same pedicle.

Lower Eyelid and Cheek Reconstruction by a Temporally Extended V-Y Cheek Flap

Reconstruction of medium and large cheek defects involving the whole length of the lower eyelid and suborbital region is a challenging procedure. Several cervicofacial flaps are well described in the literature; most of them require extensive undermining and retroauricular and cervical incisions. A case is presented of an 84-year-old woman, a smoker, with a recurrent squamous cell carcinoma on the left suborbital region. Excision resulted in a 5.5 × 3.5-cm defect of the suborbital region and the whole length of the lower eyelid. Considering that the patient was an elderly smoker, a simple technique was sought. Reconstruction was achieved by a wide temporally extended V-Y cheek flap. The extension was used to reconstruct the eyelid and the main flap to cover the cheek defect. The procedure necessitated minimal undermining and was done under local anesthesia with an excellent functional and cosmetic result.

Use of a Patient and Observer Scar Assessment Scale to Evaluate the V-Y Advancement Flap for Reconstruction of Medial Cheek Defects

The V-Y advancement flap (VYF) is not commonly used to reconstruct defects located on the medial cheek. The quantitative assessment of VYF for this indication has not been reported. In evaluation of surgical scarring, the Patient and Observer Scar Assessment Scale (POSAS) has been validated for use in burn and breast surgery scars, but its usefulness in dermatologic surgery has not been determined. To present our experience with the use of the POSAS to assess the success of VYF reconstruction for surgical defects on the medial cheek. Fourteen patients with medium to large (>5cm(2) ) medial cheek Mohs defects reconstructed using VYF were assessed. Final cosmetic and functional results were analyzed after a follow-up of 6months to 2years (mean follow-up 21months) using the POSAS. Observers using the POSAS gave a mean score for VYF reconstructions of 9.1±2.3 (5 represents normal skin, 50 represents worst imaginable scar). Patients using the POSAS gave a mean score for VYF reconstructions of 10±4 (6 representing normal skin, 60 representing worst imaginable scar). VYF reconstruction of medium to large defects of the medial cheek is a useful option. The POSAS may be a helpful tool for evaluating reconstructive results in dermatologic surgery.

Applications of Kite Flap in Reconstruction of Cheek Defects after Tumor Excision

Objectives: The main aim of this study was to present our experience with V-Y island flaps in reconstruction of the cheek defects after tumor excision in 3 facial zones. Patients and methods: 40 patients with cutaneous carcinomas of the cheek in 3 facial zones (17 SubOrbital, 19 Bucco-Mandibular and 4 Pre-Auricular) resulting from skin tumor excision were reconstructed using V-Y flaps from July 2009- June 2011. Results: 40 patients with small to medium-sized defects (3-6cm) ranging from 25 to 70 years were treated. Of these 40 patients, 17 were men (42.5%) and 23 were women (57.5%). We had no complications and the functional and aesthetic outcomes were quite acceptable. No recurrence of malignant skin tumor was observed to date (mean 1.5 yrs.). Conclusions: The kite flap is one of the methods for reconstruction of small to medium-size defects in different zones of the cheek. This method has aesthetic and functional superiority in comparison with skin grafts or other local flaps in the cheek.

Applications of Kite Flap in Reconstruction of Cheek Defects after Tumor Excision

Applications of Kite Flap in Reconstruction of Cheek Defects after Tumor Excision

Reconstruction of Full-Thickness Cheek Defects With Using Free Osseocutaneous Radial Forearm Flap

The aim of the present clinical study was to evaluate the feasibility of free osseocutaneous radial forearm flap in the reconstruction of full-thickness cheek defect after ablative cancer surgery. A retrospective review of data was obtained from consecutive patients requiring free osseocutaneous radial forearm flap to recover both the cutaneous and bone deficit in major full-thickness cheek defect after oncologic resection. Two patients had advanced cheek squamous cell carcinoma. All patients had combined bone and extensive soft-tissue defects. The free osseocutaneous radial forearm flap measuring 10 × 8 cm to 14 × 10 cm was used to reconstruct the major through-and-through cheek defects. No major complications occurred in any patient. The patients were followed up for 6 to 20 months; 1 patient was living with no evidence of disease, and 1 had died of local recurrence. The free osseocutaneous radial forearm flap to reconstruct major through-and-through cheek soft tissue and bone defects is reliable and an excellent alternative to other options for patients who have full-thickness defect of cheek.

Reconstruction of Cheek Defect with Facial Artery Perforator Flap

Reconstruction of Cheek Defect with Facial Artery Perforator Flap

Reconstruction of Major Full Cheek Defects With Combined Extensive Pedicled Supraclavicular Fasciocutaneous Island Flaps and Extended Vertical Lower Trapezius Island Myocutaneous Flaps After Ablation of Advanced Oral Cancer

The present clinical study assessed the feasibility of extensive pedicled supraclavicular fasciocutaneous island flaps combined with extended vertical lower trapezius island myocutaneous flaps for large, full-thickness cheek defect reconstruction after ablative oral cancer surgery. A retrospective review of data from consecutive patients requiring extensive pedicled supraclavicular fasciocutaneous island flaps and the extended vertical lower trapezius island myocutaneous flap to provide both an inner and an outer lining for major full-thickness cheek defects after oncologic resection. Eight patients had advanced oral squamous cell carcinoma. All patients had combined bone and extensive soft-tissue defects. The extensive pedicled supraclavicular fasciocutaneous island flap with a skin paddle measuring 10 × 8 cm to 14 × 10 cm and the extended vertical lower trapezius island myocutaneous flap with a skin paddle measuring 25 × 10 cm to 15 × 8 cm were used to reconstruct the major through-and-through defects. No major complications occurred in any patient. The patients were followed up for 6 to 20 months; 6 patients were living with no evidence of disease, 1 was living with disease, and 1 had died of local recurrence. The combined use of the extensive pedicled supraclavicular fasciocutaneous island flap with an extended vertical lower trapezius island myocutaneous flap to reconstruct major through-and-through cheek soft defects is reliable and an excellent alternative to other pedicles, even microsurgical free flaps, for patients who have previously undergone radiotherapy and surgery of the head and neck.

P197. Reconstruction of major full cheek defects with combined extensive pedicled supraclavicular fasciocutaneous island flaps and extended vertical lower trapezius island myocutaneous flaps

P197. Reconstruction of major full cheek defects with combined extensive pedicled supraclavicular fasciocutaneous island flaps and extended vertical lower trapezius island myocutaneous flaps

Reconstruction of cheek defects: a review of current techniques

The article discusses the fundamental principles of cheek reconstruction and summarizes recently published techniques and reviews in the field. Reconstruction of the cheek is a complex endeavour. Patient, defect, and potential donor site factors must be carefully considered in the restoration of cheek form and function. Fortunately the surgeon, each with his or her own personal preferences and experience, has a wealth of techniques available from which to choose. New flaps and techniques are described including recent reviews of traditional techniques. Examples include a modification to the Mustardé flap, an axial pedicled flap from the radix nasi region, a technique of superficial musculoaponeurotic system plication to achieve primary closure of large defects, and reviews of the submental island flap, the subcutaneous cervicofacial flap, the medial sural artery perforator flap, and the anterolateral thigh flap. Surgical innovation and conscientious assessments of traditional techniques continue to advance the field of cheek reconstruction towards improved aesthetic and functional outcomes.

Plication of the Superficial Musculoaponeurotic System in Reconstruction of Cheek Defects

Plication of the Superficial Musculoaponeurotic System in Reconstruction of Cheek Defects