Severe facial burn sequelae present a great challenge and maximally test the principles of reconstructive surgery. Three of these basic principles–-free tissue transfer, flap prefabrication, and tissue expansion–-are combined to achieve superior reconstructive outcomes. This approach evolved into the prefabricated induced expanded flap, which refers to the staged transfer of expanded supraclavicular skin with an antebrachial fascial free flap used as the carrier.
In the first surgical stage, the radial artery and corresponding vein in antebrachial fascia were transferred to a subcutaneous pocket in the supraclavicular fossa over a large skin expander, with anastomoses to the neck vessels. During the second stage, after adequate expansion lasting 2 to 3 months, the total scarred hemiface was excised, and the prefabricated induced expanded flap was dissected and then transferred as an island to cover the skin defect.
Twenty-six patients with severe hemifacial burn sequelae and three more with other large hemifacial lesions underwent successful facial resurfacing with the described technique in the last 7 years. Twenty patients were male and nine were female, with a mean age of 23. Mean follow-up was 3.4 years. All of the flaps survived after transfer, and no major complication was observed.
The supraclavicular prefabricated induced expanded flap can provide ample amounts of vascularized, thin, and desirable skin with perfect color match for resurfacing major facial defects. The aesthetic and functional results were encouraging and progressively improved during follow-up.
SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT.
Istanbul and Samsun, Turkey
From the Departments of Plastic, Reconstructive, and Aesthetic Surgery of Istanbul University Medical School and Ondokuz Mayis University Medical School.
Received for publication August 11, 2009; accepted November 30, 2009.
Disclosure:The authors have no financial interest to declare in relation to the content of this article.
Supplemental digital content is available for this article. A direct URL citation appears in the printed text; simply type the URL address into any Web browser to access this content. A clickable link to the material is provided in the HTML text of this article on the Journal's Web site (www.PRSJournal.com).
Murat Topalan, M.D., Abdi Ipekci Cad., Arman Palas, No. 7/11, Nisantasi, Istanbul, Turkey, email@example.com