Al Momarak, B., Mohamed, M., Hassan, M., Kotb, M. (2018). Regional Flaps in Coverage of Facial Defects: Our Experience. The Egyptian Journal of Plastic and Reconstructive Surgery, 42(1), 45-53. doi: 10.21608/ejprs.2018.215057
Belal A Al Momarak; Mohamed Elsayed Mohamed; Mohamed Ibrahim Hassan; Mohamed Osama Kotb. "Regional Flaps in Coverage of Facial Defects: Our Experience". The Egyptian Journal of Plastic and Reconstructive Surgery, 42, 1, 2018, 45-53. doi: 10.21608/ejprs.2018.215057
Al Momarak, B., Mohamed, M., Hassan, M., Kotb, M. (2018). 'Regional Flaps in Coverage of Facial Defects: Our Experience', The Egyptian Journal of Plastic and Reconstructive Surgery, 42(1), pp. 45-53. doi: 10.21608/ejprs.2018.215057
Al Momarak, B., Mohamed, M., Hassan, M., Kotb, M. Regional Flaps in Coverage of Facial Defects: Our Experience. The Egyptian Journal of Plastic and Reconstructive Surgery, 2018; 42(1): 45-53. doi: 10.21608/ejprs.2018.215057
Regional Flaps in Coverage of Facial Defects: Our Experience
The Department of Plastic Surgery, Ahmed Maher Teaching Hospital, Cairo, Egypt
Abstract
Reconstruction of acquired defects of the face remains one of the most challenging tasks for the reconstructive surgeon [1]. There are several reconstructive options for facial defects including primary repair, skin grafts, local flaps, regional flaps, or distant and free flaps. The choice of reconstructive procedure depends on several factors including size, location, and involvement of deeper structures [2]. Reliable and simultaneous reconstruction of head and neck defects has been made possible by the development and application of different flap < br />techniques. It is possible to reconstruct most defects immediately, which leads to better restoration of form and function (when rehabilitation takes place early) [3]. By the end of the 1980s and the beginning of the 1990s, free flaps became popular, and pedicled regional flaps were used with decreasing frequency. In many instances, pedicled regional or microvascular soft tissue flaps compete for the same indication, each technique with its advantages and disadvantages [4]. Larger defects require transfer of more distant soft tissue sources, such as the cervico-facial, cervico-pectoral, delto-pectoral, or pectoralis major flap [5]. For defects of the nose the "workhorse" of reconstruction including reconstruction of total nasal loss is the midline forehead flap, while defects of the Alar area may be repaired with superiorly based nasolabial flaps [6].
1. Lior H., Patrick C. and Yoav K.: Cheek Reconstruction: Current Concepts in Managing Facial Soft Tissue Loss, Semin. Plast. Surg. Nov., 22 (4): 294-305. doi: 10.1055/s- 0028-1095888, 2008. 2- Behnia H. and Motamedi M.H. Reconstruction and rehabilitation of short-range, high-velocity gunshot injury to the lower face: A case report. J. Craniomaxillofac. Surg., 25 (4): 220-7, 1997. 3- Miloro M.: Peterson’s Principals of Oral and Maxillofacial Surgery, 2nd ed. London: BC Decker, 2004. 4- Giacomo C., Karim T., Alessandro B., Fabiana A., Matteo C., Marco M. and Dimitri R.: Regional Flaps in Head and Neck Reconstruction: A Reappraisal Journal of Oral and Maxillofacial Surgery, 73 (3): March 2015. 5- Fernandes R.: Cervicofacial Advancement Flap, in Local and Regional Flaps in Head & Neck Reconstruction: A Practical Approach, John Wiley & Sons, Inc., Hoboken, NJ, USA. doi: 10.1002/9781118947272.ch13, 2014. 6- Burget G.C. and Menick F.J.: The subunit principle in nasal reconstruction. Plast. Reconstr. Surg., 76239- 247, 1985. 7- Gilas T., Sako K., Razack M.S., Bakamjian V.Y., Shedd D.P. and Calamel P.M.: Major head and neck reconstruction using the deltopectoral flap: A 20 year experience. Am. J. Surg., 152: 430, 1986. 8- Kirkby B., Krag C. and Siemssen O.J.: Experience with the deltopectoral flap. Scand. J. Plast. Reconstr. Surg., 14: 151, 1980. 52 Vol. 42, No. 1 / Regional flaps in Coverage of Facial Defects 9- Mendelson B.C., Woods J.E. and Masson J.K.: Experience with the deltopectoral flap. Plast. Reconstr. Surg., 59: 360, 1977. 10- Kingdom T.T. and Singer M.I.: Enhanced reliability and renewed applications of the deltopectoral flap in head and neck reconstruction. Laryngoscope, 106: 1230, 1996. 11- Portnoy W.M. and Arena S.: Deltopectoral island flap. Otolaryngol. Head Neck Surg., 111: 63, 1994. 12- Gingrass R.P., Culf N.K., Garrett W.S., Jr. and Mladick R.A.: Complications with the deltopectoral flap. Plast. Reconstr. Surg., 49: 501, 1972. 13- Fa-yu L., Zhong F.X., Peng L., Chang-Fu S., Rui-Wu L., Shu-Fen G., Jun-lin L., Shao-Hui H. and Xuexin T.: The versatile application of cervicofacial and cervicothoracic rotation flaps in head and neck surgery. World Journal of Surgical Oncology, 9: 135, DOI: 10.1186/1477-7819-9- 135, 2011. 14- Moore B.A., Wine T. and Netterville J.L.: Cervicofacial and cervicothoracic rotation flaps in head and neck reconstruction. Head Neck, 27: 1092-1101, 2005. 15- Croce A., Moretti A., D’Agostino L. and Neri G.: Continuing validity of pectoralis major muscle flap 25 years after its first application. Acta. Otorhinolaryngol. Ital., 23: 297-304. [PubMed], 2003. 16- Liu R., Gullane P., Brown D. and Irish J.: Pectoralis major myocutaneous pedicled flap in head and neck reconstruction: Retrospective review of indications and results in 244 consecutive cases at the Toronto General Hospital. J. Otolaryngol., 30: 34-40. [PubMed], 2001. 17- Shah J.P., Haribhakti V., Loree T.R. and Sutaria P.: Complications of the pectoralis major myocutaneous flap in head and neck reconstruction. Am. J. Surg., 160: 352-5, 1990. 18- Vartanian J.G., Carvalho A.L., Carvalho S.M., Mizobe L., Magrin J. and Kowalski L.P.: Pectoralis major and other myofascial/myocutaneous flaps in head and neck cancer reconstruction: Experience with 437 cases at a single institution. Head Neck, 26: 1018–23, 2004. 19- Mayank Tripathi,1 Sanjeev Parshad,2 Rajender Kumar Karwasra,1,2 and Virender Singh3: Pectoralis major myocutaneous flap in head and neck reconstruction: An experience in 100 consecutive cases. Natl. J. Maxillofac. Surg. Jan-Jun., 6 (1): 37-41, 2015. 20- McLean J.N., Carlson G.W. and Losken A.: The pectoralis major myocutaneous flap revisited: A reliable technique for head and neck reconstruction. Ann. Plast. Surg., 64: 570-3, 2010. 21- Zitelli J.A.: The nasolabial flap as a single-stage procedure. Arch. Dermatol., 126: 1445-8. [PubMed], 1990. 22- Zitelli J.A. and Fazio M.J.: Reconstruction of the nose with local flaps. J. Dermatol. Surg. Oncol., 17: 184-9. [PubMed], 1991. 23- Belmahi A., El Mazouz S., Gharib N.E., Bencheikh R. and Ouazzani S.: The bilobed flap: A very efficient method in aesthetic reconstruction of small skin defects at the alar and tip regions of the nose. Ann. Chir. Plast. Esthet., 48: 211-5, 2003. Egypt, J. Plast. Reconstr. Surg., January 2018 53 24- Jagdeep K. and Kaustubh S.S.: Overview of Local Flaps of the Face for Reconstruction of Cutaneous Malignancies: Single Institutional Experience of Seventy Cases. J. Cutan Aesthet. Surg. Oct-Dec., 9 (4): 220-225, 2016. 25- Stephen S. and Park, M.D.: The Single-Stage Forehead Flap in Nasal Reconstruction an Alternative with Advantages. Arch. Facial Plast. Surg., 4 (1): 32-36, 2002. 26- Millard D.R.: In: Midline forehead skin flap. Grabb's Encyclopedia of Flaps. Berish S., editor. Vol. 1. Philadelphia, PA, USA: Lippincott Williams & Wilkins, pp. 99- 100, 2009. 27- Gadre K.S., Gadre P., Sane V.D., et al.: Pectoralis major myocutaneous flap Still a workhorse for maxillofacial reconstruction in developing countries. J. Oral Maxillofac. Surg., 71: 2005.e1, 2013. 28- Hsing C.Y., Wong Y.K., Wang C.P., et al.: Comparison between free flap and pectoralis major pedicled flap for reconstruction in oral cavity cancer patients A quality of life analysis. Oral Oncol., 47: 522, 2011.
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