A Method to Reproduce Symmetry in Midfacial Reconstruction: A Report of 19 Cases

Abstract

BACKGROUND Reconstruction of facial skin defects remains a clinical challenge. With aging, ptosis of tissue over fixed structures creates an important facial feature known as the tear trough. This study aimed to evaluate the efficacy and aesthetic outcome of a novel surgical technique that reproduced this facial feature while avoiding ectropion during midfacial skin defect repair. METHODS Nineteen patients with midfacial skin defects received local flap reconstruction combined with an anchoring suture. The flap was designed in a unilateral pedicled V-Y pattern. When the flap was advanced to cover the defect, one or two sutures that connected the dermis of the flap with the infraorbital periosteum were made to reproduce the tear trough line. RESULTS: Midfacial defects were successfully repaired with the V-Y flap in all 19 patients. No lower eyelid ectropion or conspicuous scars were noted in any of the patients. Further, the tear trough was successfully reconstructed in each patient. Facial symmetry was maintained with static positioning and animation. CONCLUSIONS The combination of local V-Y flap reconstruction with anchoring sutures to reproduce facial feature lines is an effective technique in midfacial skin defect repair.

Locoregional Flaps for the Reconstruction of Midface Skin Defects: A Collection of Key Surgical Techniques

“…Due to the nature of pedunculated flaps, total flap loss is very rare. Partial flap necrosis can occur more often in rotational flaps for pedicle suffering: debridement resolves the issue and allows second-intention healing [9]. Technique complications are represented by pincushioning and standing cone deformities, more common in bilobed and rhombic flaps [10].…”

“…These flaps can be defined as donor tissue with a pedunculated axial blood supply not necessarily adjacent to the defect [1]. To date, there is no consensus on the most appropriate flap design for specific defects, especially in defects located across more midfacial subunits [9]. The most common pedicle in many of the flaps for midface reconstruction is represented by the facial artery: thanks to its course and its collateral branches, it allows almost complete coverage of the whole region [10].…”