Download PDF
J Reconstr Microsurg 2013; 29(04): 255-262
DOI: 10.1055/s-0032-1333318
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Prefabricated Neck Expanded Skin Flap with the Superficial Temporal Vessels for Facial Resurfacing

Davide Lazzeri
1   Plastic and Reconstructive Surgery Unit, Pisa, Italy
,
Weijie Su
2   Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
,
Yunliang Qian
2   Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
,
Caroline Messmer
2   Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
,
Tommaso Agostini
3   Maxillofacial Surgery Unit, Hospital of Florence, Florence, Italy
,
Giuseppe Spinelli
3   Maxillofacial Surgery Unit, Hospital of Florence, Florence, Italy
,
Jeffrey R. Marcus
4   Division of Plastic, Reconstructive, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
,
L. Scott Levin
5   Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
,
Micheal R. Zenn
4   Division of Plastic, Reconstructive, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
,
Yi Xin Zhang
2   Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
› Author Affiliations
Further Information

Publication History

22 July 2012

22 October 2012

Publication Date:
15 January 2013 (online)

    Permissions and Reprints

Abstract

Background The achievement of a normal-appearing face after surgical resurfacing remains an elusive goal. This is due in part to insufficient color matching, restoration of contours, and the persistence of visible scars. Flap prefabrication is a staged procedure that provides an independent axial blood supply to local expanded tissues. We describe a new reconstructive alternative with superior reconstructive surgical options for facial resurfacing that better matches damaged or discarded facial tissues.

Methods A superficial temporal fascial flap was harvested as the vascular supply of the prefabricated neck flap and located in a subcutaneous neck pocket over a tissue expander. After a 5-month period for expansion and maturation, the prefabricated skin flap was raised, islanded, and rotated to resurface the facial defect.

Results Four patients with hemifacial postburn contracture and two patients affected by hemifacial vascular malformations aged 17 to 42 years (mean 29 years) were successfully treated with no major complication after a mean period of 15 months.

Conclusion Prefabricated neck-expanded skin flap demonstrated an excellent color and texture match with facial skin that surrounded the repair sites, and optimal aesthetic results were obtained. Importantly, facial expression was completely maintained due to thinness and pliability of the rotated skin.

Keywords

prefabricated flap - neck - expander - hemifacial resurfacing - temporalis superficialis vessels
 

  • References

  • 1 Guo L, Pribaz J. Preexpanded ultra-thin supraclavicular flaps for (full-) face reconstruction with reduced donor-site morbidity and without the need for microsurgery (Discussion). Plast Reconstr Surg 2005; 115: 1845-1847
    PubMedGoogle Scholar
  • 2 Rose EH. Aesthetic restoration of the severely disfigured face in burn victims: a comprehensive strategy. Plast Reconstr Surg 1995; 96: 1573-1585 , discussion 1586–1587
    CrossrefPubMedGoogle Scholar
  • 3 Pallua N, Machens HG, Rennekampff O, Becker M, Berger A. The fasciocutaneous supraclavicular artery island flap for releasing postburn mentosternal contractures. Plast Reconstr Surg 1997; 99: 1878-1884 , discussion 1885–1886
    CrossrefPubMedGoogle Scholar
  • 4 MacLennan SE, Corcoran JF, Neale HW. Tissue expansion in head and neck burn reconstruction. Clin Plast Surg 2000; 27: 121-132
    PubMedGoogle Scholar
  • 5 Vinh VQ, Ogawa R, Van Anh T, Hyakusoku H. Reconstruction of neck scar contractures using supraclavicular flaps: retrospective study of 30 cases. Plast Reconstr Surg 2007; 119: 130-135
    CrossrefPubMedGoogle Scholar
  • 6 Pallua N, von Heimburg D. Pre-expanded ultra-thin supraclavicular flaps for (full-) face reconstruction with reduced donor-site morbidity and without the need for microsurgery. Plast Reconstr Surg 2005; 115: 1837-1844 , discussion 1845–1847
    CrossrefPubMedGoogle Scholar
  • 7 Yao ST. Microvascular transplantation of prefabricated free thigh flap. Plast Reconstr Surg 1982; 69: 568-569
    PubMedGoogle Scholar
  • 8 Erol OO. The transformation of a free skin graft into a vascularized pedicled flap. Plast Reconstr Surg 1976; 58: 470-477
    CrossrefPubMedGoogle Scholar
  • 9 Orgill DP, Pribaz JJ. The expanded supraclavicular flap, prefabricated with thoracoacromial vessels, for reconstruction of postburn of postburn anterior cervical contractures (Discussion). Plast Reconstr Surg 2007; Jun; 119 (7) 2078-9
    PubMedGoogle Scholar
  • 10 Topalan M, Guven E, Demirtas Y. Hemifacial resurfacing with prefabricated induced expanded supraclavicular skin flap. Plast Reconstr Surg 2010; 125: 1429-1438
    CrossrefPubMedGoogle Scholar
  • 11 Margulis A, Agam K, Icekson M, Dotan L, Yanko-Arzi R, Neuman R. The expanded supraclavicular flap, prefabricated with thoracoacromial vessels, for reconstruction of postburn anterior cervical contractures. Plast Reconstr Surg 2007; 119: 2072-2077
    CrossrefPubMedGoogle Scholar
  • 12 Li Q, Zan T, Gu B , et al. Face resurfacing using a cervicothoracic skin flap prefabricated by lateral thigh fascial flap and tissue expander. Microsurgery 2009; 29: 515-523
    CrossrefPubMedGoogle Scholar
  • 13 Hu X, Jiang C, Lin X , et al. Reconstruction of the cheek after large port-wine stain lesion resection. Aesthetic Plast Surg 2011; 35: 795-801
    CrossrefPubMedGoogle Scholar
  • 14 Teot L, Cherenfant E, Otman S, Giovannini UM. Prefabricated vascularised supraclavicular flaps for face resurfacing after postburns scarring. Lancet 2000; 355: 1695-1696
    CrossrefPubMedGoogle Scholar
  • 15 Pribaz JJ, Fine N, Orgill DP. Flap prefabrication in the head and neck: a 10-year experience. Plast Reconstr Surg 1999; 103: 808-820
    CrossrefPubMedGoogle Scholar
  • 16 Khouri RK, Ozbek MR, Hruza GJ, Young VL. Facial reconstruction with prefabricated induced expanded (PIE) supraclavicular skin flaps. Plast Reconstr Surg 1995; 95: 1007-1015 , discussion 1016–1017
    CrossrefPubMedGoogle Scholar
  • 17 Sakurai H, Takeuchi M, Nakamori D , et al. Prefabricated flap for multiple facial units reconstruction using a jejunal seromuscular patch as a vascular carrier. Burns 2010; 36: e31-e35
    CrossrefPubMedGoogle Scholar
  • 18 Vinzenz K, Holle J, Würinger E. Reconstruction of the maxilla with prefabricated scapular flaps in noma patients. Plast Reconstr Surg 2008; 121: 1964-1973
    CrossrefPubMedGoogle Scholar
  • 19 Khouri RK, Ozbek MR, Hruza GJ, Young VL. Facial reconstruction with prefabricated induced expanded (PIE) supraclavicular skin flaps. Plast Reconstr Surg 1995; 95: 1007-1015 , discussion 1016–1017
    CrossrefPubMedGoogle Scholar
  • 20 Morrison WA, Penington AJ, Kumta SK, Callan P. Clinical applications and technical limitations of prefabricated flaps. Plast Reconstr Surg 1997; 99: 378-385
    PubMedGoogle Scholar
  • 21 Liu Y, Jiao P, Tan X, Zhu S. Reconstruction of facial defects using prefabricated expanded flaps carried by temporoparietal fascia flaps. Plast Reconstr Surg 2009; 123: 556-561
    PubMedGoogle Scholar
  • 22 Erol OO, Sira M. New capillary bed formation with a surgically constructed arteriovenous fistula. Plast Reconstr Surg 1980; 66: 109-115
    CrossrefPubMedGoogle Scholar
  • 23 Austad ED. The origin of expanded tissue. Clin Plast Surg 1987; 14: 431-433
    PubMedGoogle Scholar
  • 24 Rivilis I, Milkiewicz M, Boyd P , et al. Differential involvement of MMP-2 and VEGF during muscle stretch- versus shear stress-induced angiogenesis. Am J Physiol Heart Circ Physiol 2002; 283: H1430-H1438
    PubMedGoogle Scholar
  • 25 Maitz PKM, Pribaz JJ, Hergrueter CA. Impact of tissue expansion on flap prefabrication: an experimental study in rabbits. Microsurgery 1996; 17: 35-40
    CrossrefPubMedGoogle Scholar
  • 26 Kimura N, Hasumi T, Satoh K. Prefabricated thin flap using the transversalis fascia as a carrier. Plast Reconstr Surg 2001; 108: 1972-1980 , discussion 1981
    PubMedGoogle Scholar