Pre-Expanded Arterialized Venous Free Flaps from the Forearm for Facial Burn Scars

ABSTRACT

Despite the fact that arterialized venous flaps provide thin, good quality tissue to a defect of the face and neck, their clinical applications have been limited by unstable postoperative course and necrosis of the flap. The author tried to resolve these problems by applying tissue expansion techniques to the arterialized venous flap before flap transfer. Three cases of the pre-expanded arterialized venous free flap technique were used for postburn scar contracture of the cervicofacial region. The donor site was confined to the forearm. A rectangular expander was placed over the fascia of the flexor muscles on the proximal two thirds of the forearm. The mean expansion period, volume, and flap size were 44 days, 420 cc, and 147 cm2, respectively. There were no complications caused by expander insertion and expansion. One could successfully reconstruct the facial region after excision of postburn contractures with pre-expanded arterialized venous flaps without any marginal necrosis or unstable postoperative course of the flap. Thin and large arterialized venous flaps were well matched with the recipient defect on the cervicofacial area, since the color and texture match obtained with forearm tissue produced an aesthetically favorable result. Pre-expanded arterialized venous flaps are another new option for free flap reconstruction of the face and neck.