Repair face-neck scar contracture deformity with expanded frontotemporal flap / 中华整形外科杂志

ABSTRACT

Objective@#To investigate the clinical outcome of expanded frontotemporal flap pedicled with bilateral superficial temporal vessels, in repairing facial and cervical scar contracture deformity.@*Methods@#From January 2012 to December 2017, 12 male patients with severe facial and cervical scar hyperplasia and contracture deformity, ranging from preauricular region, cheek, chin to neck, were treated in the Burn Department of the First People′s Hospital in Zhengzhou. The patients were aged at 15-58 years, with the mean age of 29.3 years. The frontotemporal scalp flaps were simultaneously expanded to prefabricate a flap pedicled with bilateral superficial temporal arteries and veins. The operations were carried out in 3 stages. Stage Ⅰ A 400-600 ml cylindrical expander was placed in the frontal region, underneath of galea aponeurosis and frontal muscle, meanwhile, a 50-100 ml cylindrical expander was placed in the temporal region on each side, between the deep temporal fascia and temporal muscle. Stage Ⅱ The expanded flap pedicled with bilateral superficial temporal vessels were received, to repair the secondary wound after scar resection and contracture release. The neck curve was reshaped. The donor area was directly sutured. Stage Ⅲ The flap pedicle was repaired, and residual scar was removed. Laser hair removal was performed on the skin flaps about 3 weeks after operation.@*Results@#Seven patients underwent simultaneously cervical and thoracic tissue expansion. The expansion time was 5-6 months (average 5.2 months). The expanded flap was 40 cm×9 cm to 45 cm×15 cm in size. All flaps survived. The venous reflux disorder after the second stage operation occurred in 1 patient. The affected area was purple and swollen. It was recovered after acupuncture and compression bandage for 1 week. Laser hair removal was performed in 8 flaps. Flap thinning was performed in 5 flaps. All 12 patients were followed up for 4 to 24 months. The flaps have good appearance, without bloating. The transferred flaps have similar color and texture with adjacent the facial skin. The cervical mobility was significantly improved. The hairline of the head was normal, and the suture scar was slight and concealed.@*Conclusions@#The expanded frontal and temporal flaps provide considerable amount of tissue with thin skin and reliable blood supply. It is an alternative method to repair facial and cervical scar contracture.