O to Z flaps in facial reconstructions
Manuel Cejudo2015, Anais Brasileiros de Dermatologia
Sign up for access to the world's latest research
checkGet notified about relevant papers
checkSave papers to use in your research
checkJoin the discussion with peers
checkTrack your impact
Abstract
Local flaps are the standard procedure to reconstruct facial defects. As it occurs in any surgical procedure, the incision should be planned so that scars are located in the minimum skin tension lines. We report two cases of O to Z flaps in the supra and infraciliary regions. One of them is a hatchet flap.
Related papers
Local Flaps in Facial Reconstruction
Journal of Oral and Maxillofacial Surgery, 2005
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
Baker shan r ed local flaps in facial reconstruction
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
Combined Flaps for Reconstructing Wide-Range Facial Defects
Aesthetic Plastic Surgery, 2011
Background This report aims to describe the technique of using combined flaps for reconstruction of wide-range facial defects. Methods 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. Results 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 9 4 to 9 9 10 cm. The healing for all the patients was uneventful, and the flap survived completely without complications. After an average of 6 months (range, 1-48 months), 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.
A retrospective study to analyze local flaps for coverage of facial defects
International Surgery Journal, 2020
Background: Face is the center of attention during communication and the expression of emotion. Facial defects resulting from trauma and the excision of skin malignancies are relatively common. How this defect is treated is determined by a variety of factors including the location, size and the underlying cause of the defect, the projected functional morbidity, the medical history of the patient, and feasibility of surgery. Aim was to study various local flaps using for coverage of defect, outcomes and complications.Methods: This was a retrospective cohort study. Our study shows result of 92 patients during January 2016 to December 2019 who had facial defects were taken up for the study. Reconstructive options were selected depending on defect size, location. Follow-up of patients ranged from 6 months to 1 year.Results: The most common malignant tumors of the face are basal cell carcinoma, squamous cell carcinoma and melanoma. Local flap is always preferable than skin grafts as it p...
The Submental Flap in Facial Reconstruction: Advantages and Limitations
Journal of Oral and Maxillofacial Surgery, 2007
Purpose: Complex defects resulting from surgical excision of facial cancer sometimes require reconstruction using microvascular free tissue transfer. Tissue transfer from areas distant from the face can resolve many problems, but often provides a poor cosmetic match with facial skin. The submental flap helps surmount this problem. Cervical skin has similarities with face skin, and because this is a regional flap, it helps eliminate microsurgical risks. In this article we present a series of 9 cases, review the anatomy and the surgical technique, and explain the advantages and limitations of the submental flap. Patients and Methods: A successive series of 9 patients in which this reconstruction was performed was reviewed retrospectively, and the results were analyzed. Results: Submental flap facial reconstruction was performed on 9 patients (8 men and 1 woman) between 1993 and 2004. Mean patient age was 53.6 years (range, 43 to 81 years). Eight of the 9 external skin coverage cases were associated with excision of cutaneous malignancies; 1 case involved treatment of burn sequelae. There were no cases of marginal mandibular nerve palsy. In 6 cases, venous drainage was disrupted after raising the flap, but without causing flap loss. This disruption was overcome in 4 to 5 days without the need for flap revision or any other interventions. Partial loss of the distal extent of the flap occurred in 2 cases. In all cases, moderately good skin color and texture match was achieved. Debulking of the flap was needed in 6 cases. The donor site recovered well with no hypertrophic scarring and no restriction to neck movement. Conclusions: The submental artery island flap is a useful reconstructive procedure that offers options to the reconstructive surgeon and has definite advantages over distant flaps in terms of ease of dissection and donor site appearance.
Versatility of Frontal Island Flaps in the Reconstruction of Periorbital Soft Tissue Defects
Journal of Craniofacial Surgery, 2007
Flaps for Oral and Maxillofacial Reconstruction: Review of Literature and a Clinical Guide to the Clinicians
Asian Journal of Oncology, 2018
There are many different ways documented for reconstruction of oral and maxillofacial (OMF) region among which the use of flaps (local or distant) is commonly practiced worldwide. Modern techniques of OMF reconstruction aim to restore function as well as improve aesthetics. This article intends to review the literature on varied flaps used in oral and maxillofacial surgery (OMFS) and summarize their precise clinical implications taking into consideration the ease, difficulties, and the ultimate clinical outcomes. A review of the literature of local or distant flaps used in OMFS was done using Google database. There are many different methods of reconstruction in patients who have had defect in the OMF region due to vascular reasons. It is important for the OMF surgeon who is involved with the management of such patients to have an understanding regarding the choice of flap used to reconstruct such defects.
Aesthetic Subunit Reconstruction Facilitated with V-Y Island Advancement Flaps on the Face
Plastic and reconstructive surgery. Global open, 2014
Skin grafted latissimus dorsi flap for reconstruction of lateral aesthetic units of the face
Microsurgery, 2014
Reconstruction of large defects of the lateral region of the face is rather challenging due to the unique color, texture, and thickness of soft tissues in this area. Microsurgical free flaps represent the gold standard, providing superior functional and aesthetic restoration. Purpose of this study was to assess reliability of skin-grafted latissimus dorsi (LD) flap, for a pleasant and symmetric reconstruction of the lateral aesthetic units of the face compared to a control group of patients addressed to perforator flaps. From November 2008 to June 2012, 5 patients underwent skin-grafted LD flap reconstruction of defects involving the lateral aesthetic units of the face, with 8.1 6 0.5 3 9.7 6 1.3 cm mean size. A 1-to-4 Likert scale was used to assess skin color, texture, shape, and bulkiness. Using the Pressure-Specified Sensory Device epicritic, proprioceptive, and protopathic sensitivities were tested. Outcomes were compared with those of a control group of 5 patients addressed to reconstruction with perforator flaps (3 anterolateral thigh flap, 2 vertical deep inferior perforator flap). At mean 21month follow-up all flaps healed uneventfully without need for revisions, all developing more satisfactory results in terms of skin color (P 5 0.028) and texture (P 5 0.021) match, shape (P 5 0.047) and bulkiness (P 5 0.012) compared with perforator flaps. No differences in epicritic, proprioceptive, and protopathic sensitivities were observed (P > 0.05) between the two groups. Skin-grafted LD flap may be a suitable option for reconstruction of wide defects of the lateral aesthetic units of the face. V
Aesthetic considerations in facial reconstructive surgery: The V-Y flap revisited
Aesthetic Plastic Surgery, 1996
The subcutaneous pedicled V-Y advancement flap (also known as the “kite flap” of Dufourmentel) has been described by many authors. Its versatility in reconstructive surgery is well known, both in facial reconstructive surgery as well as surgery of the trunk and extremities. Its advantages in achieving aesthetic reconstruction in specific facial regions have been less well emphasized in the literature. The flap can be designed within natural facial creases and heals inconspicuously because of its widely based subcutaneous or muscle pedicle which incorporates venous and lymphatic drainage over most of its length. The undesirable “biscuiting” or flap edema frequently observed with other conventional transposition flaps is avoided. We have found the V-Y flap particularly useful in reconstructing the lower eyelid/medial canthus, supra-alar, and nasolabial regions. Our experience with over 40 such flaps is described, and technical considerations in designing and elevating the flap are discussed.
Related topics
Related papers
Rotation and transposition flaps in facial plastic and reconstructive surgery
Plastic and Aesthetic Research, 2022
Reconstructive defects of the human face pose unique challenges to even the most experienced surgeon given their myriad of presentations and the individuality of each patient’s anatomy, clinical presentation, and perspective or preferences. A robust armamentarium of reconstructive options must be cultivated for each facial subunit so that experience and artistry can be best utilized to rebuild the patient’s structure and function. This review will outline a subset of local rotation and transposition flaps that are most useful for facial reconstruction, organized by facial subunit.
Pedicled Skin Flaps of the Face: What to Keep in Mind
Journal of Investigative Surgery, 2019
Forehead Flap a Workhorse Flap for Facial Reconstruction-Our Experience at Tertiary Care Institute
Background: Managing post-traumatic or post-oncosurgical facial defects presents challenges. Minor defects may be treated with skin grafts or small local flaps, while larger ones necessitate advanced techniques like tissue expanders, prefabricated flaps, or free flaps. The enduring utilization of the forehead flap over centuries underscores its reliability in reconstructing substantial and intricate facial defects. Aim: Assess the viability and adaptability of forehead flap for facial reconstruction. Materials and Methods: 20 patients who underwent coverage of facial defects after trauma or tumor excision using forehead flaps were retrospectively analysed. The patient satisfaction and flap-related complications were analyzed. Results: 20 patients (18 males and two females) underwent reconstruction of different facial defects using 20 forehead flaps. The complication occurred in one patient only. The remaining 19 patients showed no complications and passed an uneventful follow-up period. All the patients were fully satisfied. Conclusion: The forehead flap effectively addresses facial defects, likely offering optimal results with its excellent skin match in color, texture, and thickness. Despite the rising popularity of free flaps, the forehead flap remains a valid and secure choice, ensuring both aesthetic and functional success in covering facial defects.
Twenty-Five Years of Experience with the Submental Flap in Facial Reconstruction: Evolution and Technical Refinements following 311 Cases in Europe and Africa
Plastic & Reconstructive Surgery, 2019
Background: The submental flap is a pedicled island flap with excellent color match for facial reconstruction. The flap can be raised with muscle, submandibular gland, or bone and can be transposed to reach defects up to two-thirds of the face. The authors report the primary author’s (D.M.) experience of 25 years using the submental flap from its original description to most recent technical evolutions in both Europe and Africa. Methods: This is a retrospective study including all patients with facial defects who underwent reconstruction using a submental flap between 1991 and 2016. This study included the use of all four variations of the submental flap: platysmal, digastric, extended, and superextended. The authors report technical adaptations and complications encountered. Results: The authors performed 311 facial reconstructions using submental flaps: 32 platysmal, 133 digastric, 91 extended, and 45 superextended variations. In conjunction with these reconstructions, the authors...
Functional and Aesthetic Outcomes in Facial Reconstructions with Multiple Composite Axial Flaps – Case Report
International journal of medical science and clinical research studies, 2024
The article presents a case of facial reconstruction with several facial axial flaps for a posttraumatic defect of the left upper lip, medial cheek region and left nasal wing. The case refers to a 58-year-old patient who is hospitalized for a facial trauma which involves only the soft tissues, resulting from a car accident. The immediate reconstruction of all the affected aesthetic units using multiple reconstructive techniques allowed the favorable resolution of the case in the shortest possible time. We used advancement and rotation orbicularis oris innervated musculocutaneous flaps for reconstruction of the left upper lip, cervicofacial cutaneous flap for the medial cheek defect and composite forehead flap for the reconstruction of the left nasal wing. The simultaneous use of different types of flaps made possible the total healing after 4 weeks after the accident and the social and professional integration of the patient. Complex facial trauma often involves both skeletal and soft tissue damage, presenting significant challenges in both initial management and long-term reconstruction. These injuries can result from various etiologies including motor vehicle accidents, assaults, sports injuries, and falls. Effective treatment requires a multidisciplinary approach to address the intricate anatomy and functional importance of facial structures.
Overview of local flaps of the face for reconstruction of cutaneous malignancies: Single institutional experience of seventy cases
Journal of Cutaneous and Aesthetic Surgery, 2016
The most common malignant tumours of the face are basal cell carcinoma, squamous cell carcinoma and melanoma. While the results of skin graft are less than satisfactory for large areas to cover, distant flaps are bulky with a poor colour match. Local fasciocutaneous flaps provide reasonable option for reconstruction of facial defects with good colour and texture match and good success rate. Aims: This study aimed to analyse the various modalities of reconstruction after resection of facial malignancies and their advantages and disadvantages. Settings and Design: This was a retrospective study. Materials and Methods: Of 70 patients, 34 were managed with V-Y advancement flap, 24 with nasolabial flap, 8 with median forehead flap and 4 with standard forehead flap cover. The duration of follow-up ranged from 6 months to 2 years. Statistical Analysis Used: Nil. Results: Of 34 V-Y advancement flaps, 2 showed suture dehiscence at the apex of triangle which was allowed to heal secondarily with regular dressings. All the 24 nasolabial flaps were healthy without any complication. All patients had satisfactory functional and cosmetic outcomes. Conclusions: In our experience, local flaps give the best results and are the first choice for reconstruction of the face. Most defects can be best closed by nasolabial, V-Y advancement and forehead flap. Outstanding functional and cosmetic results can be achieved. Proper execution requires considerable technical skill and experience.
Omental free flap reconstruction in complex head and neck deformities
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2002
BackgroundMicrovascular free flaps continue to revolutionize coverage options in head and neck reconstruction. This article reviews our 25-year experience with omental free tissue transfers.Microvascular free flaps continue to revolutionize coverage options in head and neck reconstruction. This article reviews our 25-year experience with omental free tissue transfers.MethodsAll patients who underwent free omental transfer to the head and neck region were reviewed.All patients who underwent free omental transfer to the head and neck region were reviewed.ResultsFifty-five patients were included with omental transfers to the scalp (25%), craniofacial (62%), and neck (13%) region. Indications were tumor resections, burn wound, hemifacial atrophy, trauma, and moyamoya disease. Average follow-up was 3.1 years (range, 2 months–13 years). Donor site morbidities included abdominal wound infection, gastric outlet obstruction, and postoperative bleeding. Recipient site morbidities included partial flap loss in four patients (7%) total flap loss in two patients (3.6%), and three hematomas.Fifty-five patients were included with omental transfers to the scalp (25%), craniofacial (62%), and neck (13%) region. Indications were tumor resections, burn wound, hemifacial atrophy, trauma, and moyamoya disease. Average follow-up was 3.1 years (range, 2 months–13 years). Donor site morbidities included abdominal wound infection, gastric outlet obstruction, and postoperative bleeding. Recipient site morbidities included partial flap loss in four patients (7%) total flap loss in two patients (3.6%), and three hematomas.ConclusionsThe omental free flap has acceptable abdominal morbidity and provides sufficient soft tissue coverage with a 96.4% survival. The thickness \and versatility of omentum provide sufficient contour molding for craniofacial reconstruction. It is an attractive alternative for reconstruction of large scalp defects and badly irradiated tissue. © 2002 Wiley Periodicals, Inc. Head Neck 24: 326–331, 2002; DOI 10.1002/hed.10082The omental free flap has acceptable abdominal morbidity and provides sufficient soft tissue coverage with a 96.4% survival. The thickness \and versatility of omentum provide sufficient contour molding for craniofacial reconstruction. It is an attractive alternative for reconstruction of large scalp defects and badly irradiated tissue. © 2002 Wiley Periodicals, Inc. Head Neck 24: 326–331, 2002; DOI 10.1002/hed.10082
Survival and aesthetic outcome of local flaps used for reconstruction of face defects after excision of skin malignancies: Multi-institutional experience of 175 cases
Background: Local facial flaps are frequently used reconstructive option and are carrying very good outcome as regard matching, texture, and less scarring. This study was designed retrospectively to evaluate the flap survival and aesthetic outcome of the three commonly used local facial flaps. Material and methods: Retrospective analysis of 175 patients whom were managed by local fasciocutanous flap reconstruction using advancement flap, nasolabial flap, and forehead flap. Results: Total flap survivals. Of 80 patients of advancement flaps 8 showed flap edge dehiscence, but all healed conservatively. Of 10 flaps underwent transposition local flaps in the nose, no any flap shows dehiscence. Of 52 nasolabial flaps, 2 showed dehiscence and of 33 forehead flaps, one showed dehiscence. All flaps were survived without any complications and V-Y advancement flaps were carried out the best aesthetic outcome. Conclusion: Local face flaps for reconstruction of post malignancy facial defects are carrying a sensational survival, however advancement flap carries the best aesthetic outcome.
The H-flap: a useful flap for forehead reconstruction
British Journal of Plastic Surgery, 2001
We have found that double opposing rectangular advancement flaps in the forehead may be easily performed under either local or general anaesthesia, and are associated with high patient satisfaction and low morbidity. We claim no originality for the mode of reconstruction, but highlight its broad spectrum of application and its popularity with junior plastic surgeons passing through our unit. We have found that the term 'H-flap' provides a readily communicated alternative to 'double opposing rectangular advancement flaps'.
Loading Preview
Sorry, preview is currently unavailable. You can download the paper by clicking the button above.