ABSTRACT
Objective@#To summarize clinical experience on reconstruction of severe facial disfigurement with flap prefabrication and soft tissue expansion.@*Methods@#From September 2005 to June 2016, 49 patients with type Ⅲ and type Ⅳ facial deformities underwent facial reconstruction with an integrated method on the basis of prefabricated flaps. In the first stage, the descending branch of the lateral femoral circumflex vessels and the surrounding muscle fascia were dissected and transferred to subcutaneous pocket in the cervicothoracic area. The pedicles of the fascial flap were anastomosed to either the facial or superior thyroid artery and their venae comitantes in flap prefabrication. A tissue expander was placed beneath the fascial flap. In the second stage, over-expansion was achieved with intra-flap stem cell transplantation once patient′s skin showed signs of intolerance to expansion. In the third stage, prefabricated flap was transferred to cover the facial defects. the second or third internal mammary artery perforators or lateral thoracic artery perforators were reserved and flap supercharging would be performed depending on the perfusion of the flap revealed by indocyanine green angiography intra-operatively. Later, flap revisions further restored facial outline and delicate organ configuration. Aesthetic and functional status were independently graded to assess the facial appearance and function before and after the reconstruction.@*Results@#49 patients with severe facial deformities were included. 5 patients received stem cell transplantation. The final inflated volume ranged from 2 530 ml to 3500 ml and each patient had facial reconstruction with a prefabricated flap (range 23 cm×18 cm-34 cm×32 cm). Flap supercharging technique were used in 25 cases to augment blood perfusion, however, flap necrosis (5 cm× 2 cm) occurred in 1 patient, and tip necrosis occurred in 4 patients, otherwise, all flaps survived entirely. The aesthetic (1.15 to 2.29) and functional (0.86 to 2.42) status scores were statistically improved (P<0.01). Facial expressions such as smiling, blinking and frowning were noted.@*Conclusions@#Autologous full face reconstruction with an integrated method based on flap prefabrication can bring satisfying aesthetic and functional recovery, rendering a safe and effective option for most patients with massive facial defects.
ABSTRACT
Severe defects and deformities of face and neck normally arise from burns, tumor extirpation and trauma. They had long been a major therapeutic challenge in the realm of plastic and reconstructive surgery on account of massive involvement of skin and soft tissues, combined composite tissue injuries, high demands on aesthetic and functional outcomes, and scarce suitable reconstructive materials. After an extensive review of literature published recently, this article delineated up-to-date developments in autologous reconstruction and face allotransplantation, especially their indications and limitations in treating these patients. Meanwhile, an outlook on opportunities and challenges of these two treatment modalities was given.
ABSTRACT
Severe defects and deformities of face and neck normally arise from burns, tumor extirpation and trauma. They had long been a major therapeutic challenge in the realm of plastic and reconstructive surgery on account of massive involvement of skin and soft tissues, combined composite tissue injuries, high demands on aesthetic and functional outcomes, and scarce suitable reconstructive materials. After an extensive review of literature published recently, this article delineated up-to-date developments in autologous reconstruction and face allotransplantation, especially their indications and limitations in treating these patients. Meanwhile, an outlook on opportunities and challenges of these two treatment modalities was given.