Sir:
The reconstruction of large facial defects presents a challenging problem for plastic surgeons. To achieve a better repair of facial soft-tissue defects, we use the cervical expanded skin flap prefabricated with the superficial temporal vessel. Prefabrication was first tried by Washio on dogs in 1971.1 2 3
First, a Doppler bloodstream radiometer is used to determine the course of the superficial temporal artery and its parietal branch, which are then labeled (Fig. 1 ). With the patient under local anesthesia, we dissect the superficial temporal vessel along with its fascia. We make a 5- to 6-cm-long infrajaw incision, sharply separate the superficial layer of platysma muscle, and then form a capsule of appropriate size, with hemostasis. Between the infrajaw incision and the initiation part of the superficial temporal vessel before the ear, we form an appropriate subcutaneous tunnel, and transfer the superficial temporal vessel wrapped with rubber membrane through the preauricular subcutaneous tunnel to the neck. We suture the superficial temporal vessel to the subcutaneous tissue of the capsule and fix it. We then implant a suitable expander into the cervical capsule. After the expansion is completed, we perform a second-stage operation. With the patient under local anesthesia, we illuminate the expanded skin flap, determine the course of the superficial temporal vessel using a Doppler probe, and design the skin flap according to the size and shape of the facial defect. We dissect the defect, with hemostasis, take out the expander integrally, and then form an islanded cervical expanded skin flap, with the superficial temporal vessel as the pedicle. Through the preauricular subcutaneous tunnel, we transfer the skin flap to the facial wound. We check the blood supply of the flap, and layer by layer we suture the cervical and facial incisions. We insert a drainage tube and bandage the patient, and then 7 to 10 days later we remove the stitches (Fig. 2 ). At the 12-month follow-up visit, the patient’s facial malformation was well corrected, the skin flap’s color and luster were similar to that of normal skin, and the secondary cervical scar was not obvious.
Fig. 1.:
Preoperative view of facial hemangioma.
Fig. 2.:
Appearance of the patient 1 week after a prefabricated cervical expanded skin flap was used to repair a facial defect.
The key points of this treatment are as follows: (1) preoperative planning and detection of the course of the superficial temporal vessel; (2) normal cervical skin that can provide enough expanded skin to cover the facial defect; (3) fine dissection and transfer of the superficial temporal vessel to the expanded flap; and (4) reconstruction of the facial defect using the prefabricated cervical expanded skin flap as a vascularized, pedicled skin flap.
The method described has several advantages, including the constant course of the superficial temporal vessel and its easy dissection. The color and texture ofcervical skin are comparatively similar to those of facial skin, and the prefabricated flaps are very safe and well supplied by blood. The aesthetic results are satisfying. The determining factors of the size of the prefabricated skin flap and the revascularization time require further study.
Xinhai Liu, M.D.
Senkai Li, M.D.
Yangqun Li, M.D.
Plastic Surgery Hospital
Chinese Academy of Medical Sciences
Beijing, China
REFERENCES
1. Washio, H. An intestinal conduit for transplantation of other tissue.
Plast. Reconstr. Surg. 48: 48, 1971.
2. Shen, T. Vascular implantation into skin flap experimental study and clinical application: A preliminary report.
Plast. Reconstr. Surg. 68: 404, 1981.
3. Pribaz, J. J., Fine, N. A., and Orgill, O. P. Flap prefabrication in the head and neck: A 10-year experience.
Plast. Reconstr. Surg. 103: 808, 1999.
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