Reconstruction of the lower eye lid with a rotation-advancement tarsoconjunctival cheek flap

Repair of full-thickness defects of the lower eyelids poses a challenge because a graft in combination with a flap is typically used to replace either the posterior or the anterior lamella. This often results in aesthetically and functional unsatisfactory outcomes. A rotation-advancement tarsoconjunctival cheek flap, which reconstructs both posterior and anterior lamellae with vascularized tissue similar to the native eyelid, is described. Nine patients underwent reconstruction with a rotation-advancement tarsoconjunctival cheek flap. Indications, complications, and outcomes were evaluated. The follow-up time ranged from 6 to 60 months, with a mean of 23 months. The main indication for use of this flap is full-thickness defect of the lower eyelid between 25% and 75%, typically after tumor ablation. All patients had a functional and aesthetically satisfactory outcome. One patient underwent a revision canthoplasty. The rotation-advancement tarsoconjunctival cheek flap adheres to basic plastic surgery principles resulting in a satisfactory outcome: vascularized tissue is used to reconstruct the defect, the flap composition is similar to the native eyelid, that is, replace like with like, and the flap makes use of tissue that is in excess and therefore limits donor morbidity.     

Hard palate mucoperiosteal graft for posterior lamellar reconstruction of the upper eyelid: histologic rationale

Reconstruction of full-thickness upper eyelid defects often requires repair of both the anterior lamella (skin and orbicularis oculis muscle) and the posterior lamella (tarsus and conjunctiva). Various autogenous grafts have been used for posterior lamellar reconstruction, but it is still unclear which material is most suitable for repairing the posterior lamella. We report a patient in whom a subtotal defect of upper eyelid was reconstructed with a bipedicled myocutaneous flap lined by hard palate mucoperiosteum. We also examined tarsoconjunctiva, labial mucosa, hard palate mucoperiosteum, and auricular cartilage histologically and assessed the histologic features of these tissues as substitutes for the posterior lamella. An even and stable upper eyelid was formed by our method of reconstruction. A mucoperiosteal graft from the hard palate bears a close resemblance to the tarsoconjunctiva histologically because it contains both fibrous connective tissue and a mucous membrane. The graft took completely and there was no donor site morbidity or postoperative complications. A hard palate mucoperiosteal graft may be an optimal substitute for the posterior lamella of the upper eyelid.     

Frontotemporal fasciocutaneous island flap for facial aesthetic subunit reconstruction

The frontotemporal fasciocutaneous island flap is a useful source of tissue for correcting aesthetic units of the face. The quality of the tissue may be enhanced, and a successful color and texture match may be achieved. This flap is based on the temporal vessel system and its own fascia. Its provides excellent venous drainage and its pedicle length and arc of rotation may be increased. The donor scar is hidden under the hair-bearing area. The frontotemporal fasciocutaneous island flap was used in patients with inferior eyelid defects, for cheek reconstruction, for providing coverage of superior and inferior lip defects, for restoring the normal anatomy of columellar defects, and for reestablishing the contour of menton defects. The frontotemporal fasciocutaneous island flap was employed successfully in 9 patients at the Hospital Gea Gonzalez. The wide treatment possibilities for the reconstruction of aesthetic units in the face with the frontotemporal fasciocutaneous island flap are illustrated.     

Upper eyelid reconstruction with a hard palate mucosa-lined bipedicled myocutaneous flap

The upper eyelid is very difficult to reconstruct because smooth opening and closure of the eyelid must be maintained. A patient is presented in whom a hard palate mucosa-lined bipedicled myocutaneous flap containing innervated orbicularis oculi was used to successfully reconstruct a subtotal upper eyelid defect. Good functional and aesthetic results were achieved. This method may be a good alternative for reconstruction of large upper eyelid defects.     

A comparison of vascularized fibular flap and iliac crest flap for mandibular reconstruction

Segmental mandibular defects, which are caused either by ablative surgery or trauma, are usually accompanied by different degrees of skin, soft tissue or mucosa losses. The reconstruction of such defects requires complicated surgical procedures.An ideal mandibular reconstruction method must support the insertion osseointegrated dental implants which is necessary for total oral rehabilitation. The soft tissue defect should also be reconstructed if it accompanies the bony defect. We performed 37 mandibular reconstructions using either vascularized iliac crest flap or fibula flap. Sixteen of 24 patients who underwent mandibular reconstruction using iliac crest flap, and 3 of 13 patients who has been reconstructed with fibula flaps, had mandibular defects involving skin and/or mucosa. Both techniques were compared regarding patients records such as hospital stay, operation time, defect size, etiopathogenesis, skin paddle, blood transfusion, and complication rates. Self-assessment questionnaires were also used to evaluate aesthetic and functional results.When 2 different mandibular reconstruction techniques are compared regarding patient records, the complication rate of fibula flap was less than the iliac crest flap. Functional and aesthetic results also showed that oral continence, social activities, and facial appearance rates of fibula flap were superior to iliac crest flap. Lower complication rates of fibula flap group may be associated with patients' higher satisfaction rate.Both flaps are commonly used in mandibular reconstruction, however, many parameters including defect localization, defect size, presence of soft tissue defect should be considered.     

Temporalis muscle flap for immediate reconstruction of maxillary defects: review of 39 cases

This study evaluated the advantages and complications associated with immediate reconstruction of maxillary defects after maxillectomy and the relationship between defect tissues classification and postoperative results after using the temporalis muscle flap. In this retrospective study, the records of 39 patients who underwent immediate reconstruction surgery using temparolis myofascial flap following maxillectomy from April 1989 to February 2009 were reviewed. Demographic data, features of the disease, follow-up, outcome and complications were analysed. Patients were classified into three groups, to ascertain the influence between defect classification and functional results, aesthetic outcomes and complications in each group. Of the 39 cases, all tissue flaps survived. 5 patients underwent postoperative radiotherapy, which did not seem to influence the outcome of the reconstructive procedure. There was one case of oroantral fistula, which could easily be obturated with the prosthesis. One patient developed haematoma in the donor site 5 days after surgery. Postoperative speech was good, facial appearance was normal and ocular function remained unchanged. Postoperative aesthetic and functional results were satisfying. The temporalis muscle flap can be considered as a first-line reconstructive option for maxillary defects. Acceptable functional and aesthetic outcomes can be expected in high rates.     

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目的探讨游离皮瓣在全下唇及颏部大范围缺损修复重建中的应用价值及临床效果。方法 2007年7月至2013年3月,对中国医科大学口腔医学院口腔颌面外科收治的12例下唇癌根治术后及2例外伤造成的全下唇及颏部缺损患者,应用前臂皮瓣和股前外侧皮瓣同期修复。术后随访6个月至3年,并对患者修复后下唇外观和功能进行评价。结果 14例皮瓣全部成活,成活率100%。术后随访下唇癌患者肿瘤未见复发,14例患者均可进行基本正常的语言交流;12例可进普食,2例进软食;1例流涎,均无小口畸形。下唇及颏部外观患者均能接受。结论应用游离皮瓣修复全下唇及颏部缺损,方法安全可靠且成功率较高,根据下唇及颏部缺损范围选择合适修复方式可获得较好的口腔功能和外观。     

双颏神经血管蒂V-Y岛状推进皮瓣联合舌瓣功能性重建完全性下唇缺损

目的:评价双颏神经血管蒂V-Y岛状推进皮瓣联合舌瓣功能性重建完全性下唇缺损的效果。方法:对9例唇癌患者进行肿瘤切除术,并利用以颏神经血管束为蒂的双颏V-Y岛状推进皮瓣联合舌瓣功能性重建下唇缺损。结果:皮瓣存活率达100%。随访6～20个月,患者唇部功能、感觉正常,且形态美观;均无局部复发或淋巴结转移。结论:双颏神经血管蒂V-Y岛状推进皮瓣联合舌瓣是唇癌切除后造成完全性下唇缺损的理想功能性修复方法。     

Double mental neurovascular V-Y island advancement flaps combined with tongue flaps for functionally reconstructing total lower-lip defects

Although several techniques have been described for lower-lip reconstruction, functional reconstruction of total lower-lip defects remains a challenge. This study investigated a functional reconstruction technique for total lower-lip defects. Nine lower-lip defects were reconstructed after cancer ablation using double mental V-Y island advancement flaps, based on mental neurovascular bundle combined with tongue flaps. All flaps survived completely. The patients were followed up for 6 to 20 months. The lip function and sensation were normal, and aesthetic appearance was satisfactory. No patient developed local recurrence or lymphatic metastasis. The technique of combining a double mental neurovascular V-Y island advancement flap with a lingual mucosal membrane flap is ideal for the functional repair of total lower-lip defects after cancer ablation.     

Orbicularis oculi myocutaneous island flap for upper eyelid reconstruction

The cosmetic and functional outcomes of a reconstruction of an upper eyelid defect due to trauma or neoplasm are very important. This article reports the technique of an orbicularis oculi myocutaneous island flap for covering small- to moderate-sized defects of the upper eyelid. Between March 2008 and March 2010, 5 patients underwent surgery for an upper eyelid reconstruction. After tumor excision and debridement, the eyelid margin was closed directly before the reconstruction. The flap was designed just beside the defect considering the amount of tissue remaining for the reconstruction. The flap was elevated by splitting the muscle by the direction of its fibers without damaging the pedicle. The elevated flap was then transposed to the defect without tension.The orbicularis oculi myocutaneous flap is a single-stage reconstruction with reliable vascularity. It can be used to cover a defect without compromising the primary closure of the donor site and can be customized to reconstruct the defect with minimal tissue. Therefore, an orbicularis oculi myocutaneous island flap can be an alternative for a single-stage reconstruction of small- to moderate-sized defects of the upper eyelid.     

The Guyuron retroauricular island flap for eyelid and eye socket reconstruction in children

A complete loss of palpebral tissue can occur following a congenital malformation, tumour resection or traumatic injury. This article presents the authors’ clinical experience with upper eyelid reconstruction in children using the Guyuron retroauricular island flap. Five cases of severe eyelid defects in children aged between 5 days and 10 years of age (three patients following enucleation and two presenting upper eyelid coloboma of approximately two-thirds of the upper eyelid surface) were treated using this technique. In all cases an optimal closure of the eyelid fissure was achieved and corneal exposure clinically improved. On average, 15% of the initial flap surface was lost. Only one major complication (40% flap necrosis) was reported in the postoperative period. This reconstructive technique can provide complete eyelid reconstruction leaving an inconspicuous scar and causing limited morbidity at the donor zone.     

小腿外侧皮瓣在口腔内缺损修复中的应用：附9例报道

目的研究小腿外侧皮瓣在口腔颌面软组织缺损修复中的应用。方法应用该修复方法，共进行了９例口腔颌面部肿瘤术后缺损的修复，并对该皮瓣的应用解剖，制作技术及其优缺点进行了讨论。结果应用的９侧小腿外侧皮瓣均获得成功。结论小腿外侧皮瓣，修复口腔颌面部肿瘤术后的软组织缺损并和腓骨肌皮瓣共蒂和串联修复软组织缺损均是一种可取方法     

Facial reconstruction with latissimus dorsi myocutaneous island flap following total maxillectomy

Following total maxillectomy for maxillary cancer, facial reconstruction was performed using a latissimus dorsi myocutaneous island flap. Postreconstructive deformity was studied in 10 patients. In 5 patients, after simple total maxillectomy the inner raw surface of the facial skin and orbito was covered by the flap, and the other extended total maxillectomy patients where the orbital contents and facial skin were involved, reconstruction was by means of the folded flap. In the patients with simple total maxillectomy, cicatricial contracture of the facial skin and cicatricial ectropion of the lower eyelid were quite small, and in the patients with extended total maxillectomy, reconstructed facial skin did not give rise to cicatricial contracture.     

Prospective comparative study of lower lip defects reconstruction with different local flaps

Squamous cell carcinoma is the most common malignancy related to the lips (95%), and the lower lip is more commonly involved. Loss of tissue in the lower lip is treated with a variety of techniques, depending on the extension and location of the defect. This was a prospective case series. In this study, 41 patients with squamous cell carcinoma (30 males, 11 females) who were referred to Razi Hospital of Tehran University of Medical Sciences between 2007 and 2008 and underwent lower-lip reconstruction were included. Defects were divided into 4 groups: less than 30%, between 30% and 50%, between 50% and 80%, and more than 80%. Five different local flaps were used for lower-lip reconstruction. Karapandzic flap was used for 9 patients, double reversed-Abbe flap for 6 patients, Abbe-Estlander and step-ladder flaps for 8 patients, and 10 patients underwent reconstruction operation with reversed-Abbe flap. In comparison to reversed-Abbe flap and step-ladder flap, there were no differences functionally and aesthetically except that the step-ladder flap was a single-stage procedure, but the reversed-Abbe flap had 2 stages. There were no functional problems in patients with Estlander flap, but these patients complained of lip asymmetry. There were no functional complaints and aesthetic problems in patients with double reversed-Abbe flap at 3 months after the operation. In patients with 30% to 50% defect of the lower lip, there was no functional and aesthetic difference between Abbe flap and step-ladder flap. Estlander flap is a good choice for reconstruction of lateral or commissural defects of the lower lip. In patients with 50% to 80% defect, it is better to use bilateral reversed-Abbe instead of the Karapandzic flap.     

A comparative study on superior auricular artery island flaps with various pedicles for repair of periorbital defects

Superior auricular artery (SAA) island flaps elevated from the retroauricular region have perfect color, thickness, and texture match with facial skin. In this article, reconstruction of periorbital defects with SAA island flaps is presented. Flaps were categorized into three types because they were elevated on three different pedicles. A type 1 flap was a superficial temporal vessel pedicled SAA island flap with antegrade blood flow. A type 2 flap was a reverse flow SAA island flap based on the frontal branch of the superficial temporal artery (STA). A type 3 flap was a reverse flow SAA island flap based on the parietal branch of STA. Fourteen patients (9 females and 5 males) aged between 31 years and 74 years were treated with these flaps. Two patients with lower eyelid, two patients with upper eyelid, three patients with malar, two patients with infraorbital, one patient with lateral canthal upper eyelid, and four patients with forehead defects underwent surgical intervention. Sizes of the flaps varied between 3x6 cm and 8x6 cm. Venous congestion was observed in all patients in the early postoperative period and lasted for 5 to 9 (mean, 6.6) days in type 1 flap, 5 to 9 (mean, 6.7) days in type 2 flap, and 2 to 5 (mean, 3.6) days in type 3 flap. Apart from distal necrosis of 1x1 cm in one patient and superficial dermal sloughing in two patients, no complications were encountered. Aesthetically and functionally successful results with minimal donor site morbidity were obtained in all patients during the 2 to 22 (mean 10.8) month follow-up period.     

Hemiforehead flap for reconstruction of composite facial defects

Composite defects overlap 2 or more facial units. It is difficult to reconstruct composite defects with adequate shape, color, and texture. Because it is non-hair bearing, is relatively thin, and has a color and texture similar to that of the rest of the face, the skin of the forehead possesses excellent characteristics for nasal reconstruction and repair of other facial areas. The authors developed an extended thin forehead flap (hemiforehead flap) that includes half of the total forehead skin and is based on supratrochlear vessels. In the patient reported here, a hemiforehead flap was used to reconstruct composite defects of the lower lid, cheek, nose, and upper lip. Acceptable aesthetic and functional results were achieved. This flap may serve as an alternative for reconstruction of composite facial defects.     

Indications for reconstruction of mucosal defects in oropharyngeal cancer using a supraclavicular island flap

The use of the supraclavicular island flap (SCIF) for the reconstruction of facial and neck skin defects is increasing. The value of this fasciocutaneous flap as a reconstructive modality for oropharyngeal defects in cancer patients is unclear. In the present study, a SCIF was used for reconstruction of mucosal defects following resection of the tumour in a group of four patients with T2 squamous cell carcinoma of the oropharynx and a clinical N0 neck. Reconstruction was performed following transoral tumour resection and selective neck dissection at levels I–III in the same session. Intraoperative and postoperative complications were analyzed, and functional and aesthetic results for the neck and shoulder region were evaluated in follow-up examinations. In addition, sensation to the flap was evaluated. No flap failures were observed. Only minor surgical complications were evident, which did not cause any relevant functional or aesthetic impairments. Sensation to the flap was observed in all cases. The SCIF appears to be a good and time-saving alternative to free flaps for oropharyngeal reconstruction following oncological resection in selected patients.     

The perichondrial cutaneous graft and "flip-flop" flap in facial reconstruction: a series of 41 cases

Reconstruction of defects of the nose and eyelids can be challenging. The standard surgical options include full thickness skin grafts and local flaps. Another technique that offers a reliable and dimensionally stable one-stage reconstruction is the perichondrial cutaneous graft. The donor site is closed with the postauricular flip-flop flap. We have used these techniques in a series of 41 consecutive patients. Good or excellent aesthetic reconstructions were obtained in 39 cases, with 3 complications: 1 failed graft, and 2 small postauricular wound dehiscences. The perichondrial cutaneous graft can produce excellent cosmetic results when it is used to reconstruct complex defects of the nose and eyelid. Closure of the donor site in the conchal bowl with the flip-flop flap is a reliable and elegant technique.     

Versatile use of submental tissue for reconstruction of perioral soft tissue defects

To obtain optimum aesthetic result, perioral soft tissue defects require reconstruction using similar tissue. The submental area has very similar characteristics to perioral soft tissue and consists of thin, pliable tissue with a perfect color match. Therefore, we have used submental tissues for reconstruction of perioral soft tissue defects and application of the techniques, and results are discussed in this article. Between February 2001 and April 2008, 14 perioral soft tissue reconstruction procedures using the submental tissues were performed. The defect was on the upper lip including nasal columella in 5 cases, mentum in 3 cases, and oral commissure including buccal cheek in 6 cases. The techniques that were used included composite graft in 3 cases, local advancement flap in 3 cases, pedicled flap in 5 cases, and free flap in 3 cases. Patients were followed up for 9 months to 5 years. During this period, no major complications were noted, and satisfactory aesthetic results were obtained. All transferred submental tissues survived. In all patients, donor defects were closed primarily except in cases of local advancement flap. The donor-site scar was inconspicuous and well hidden below the mandibular margin and did not restrict neck motion in all patients. In particular, hair restoration on the flap was excellent in male patients. We believe that the submental area can provide useful soft tissue for perioral soft tissue defects because it provides a good color and texture match with perioral skin and can be harvested with minimal donor-site morbidity.     

Comparison of aesthetic outcome of different facial reconstruction techniques after resection of cutaneous squamous cell carcinoma

PurposeThe aim of the study was to compare local and distant flaps for facial reconstruction after resection of cutaneous squamous cell carcinoma.Patients and methodFifty patients with facial CSCC and subsequent facial reconstruction were retrospectively analysed. All complications such as wound infection, wound dehiscence, flap necrosis, partial or total flap loss were recorded. The aesthetic outcome was evaluated using colour prints of patients’ photographs of different flaps in terms of skin colour, texture and scars by three judges. To compare the aesthetic outcome of distant and local flaps a Wilcoxon-Mann-Whitney-U-Test was applied.ResultsThe overall complication rate was low. Colour and texture of local flaps presented statistically significantly better results compared to distant flaps. There were no statistically significant differences between scars of local flaps and distant flaps (p = 0.528). A slight tendency was found showing scars of local flaps to be less visible than scars of distant flaps in defects extending in more than one facial aesthetic unit.ConclusionLocal flaps show statistically significant ly better aesthetic results compared to distant flaps in terms of colour and texture. Scars of local flaps seem to be slightly less visible compared to distant flaps in cases where defects were bridging more than one facial aesthetic unit. We conclude that local flaps should be preferred over free flaps whenever possible as far as the aesthetic outcome is concerned.