ABSTRACT
<p><b>OBJECTIVE</b>To explore a combined application of tissue expansion, perforator flaps and super-thin flaps in reconstruction of extensive face and neck scars.</p><p><b>METHODS</b>In the first stage, the position and course of the perforators were confirmed with the multi-detector computed tomography ( MDCT) and color Doppler ultrasound. The expanders were implanted between subdermal vascular plexus and superficial fascia. In the second stage, the expanded super-thin perforator flaps were transferred to resurface the extensive defects and deformities in the face and neck.</p><p><b>RESULTS</b>26 cases with extensive facial and cervical scars were included in this study. Except for one case with necrosis at the distal end, the other 25 flaps survived completely. The maximum flap size was 35 cm x 10 cm with a pedicle of 8 cm x 4 cm. Long-term follow-up showed that this combined application provided thinner flap than the conventional pre-expanded flap, thus avoiding secondary flap debulking and revisions. All the patients got improvement in contours, facial features and emotional expression.</p><p><b>CONCLUSIONS</b>The combined application of tissue expansion, perforator flaps and super-thin flaps is a practical method which has advantages in feature recontouring and recovery of delicate emotions in reconstruction of extensive face and neck scars.</p>