An Inferiorly Based Rotation Flap for Defects Involving the Lower Eyelid and Medial Cheek

Lewin, John M.; Sclafani, Anthony P.; Carucci, John A.

doi:10.1055/s-0035-1562879

Cited by 11 publications

(10 citation statements)

References 13 publications

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“…Past reports have discussed this repair approach for defects smaller than 3.2 to 3.4 cm in longest diameter. 5,6 In this series, defects up to 5.5 cm were successfully repaired with an inferiorly based flap with acceptable cosmetic outcomes based on the VAS.…”

Section: Discussionmentioning

confidence: 92%

Inferiorly Based Rotation Flaps for Infraorbital Cheek Defects

et al. 2021

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BACKGROUND The infraorbital cheek is a common location for cutaneous malignancy and thus surgical defects. Reconstruction in this region must maintain nearby free margins to ensure optimal cosmetic and functional outcomes. Large defects may require a flap using lateral or inferior tissue reservoirs. OBJECTIVE To examine outcomes of inferiorly based rotation flaps in the repair of infraorbital cheek defects and highlight pearls for optimal long-term results. METHODS Chart review of patients with a defect of the infraorbital cheek repaired with an inferiorly based rotation flap between February 2010 and December 2018 at a single academic institution. The Visual Analog Scale (VAS) was used for scar assessment. RESULTS Sixty-five patients underwent extirpation of a cutaneous malignancy resulting in defects ranging from 1.0 3 1.0 to 4.5 3 5.5 cm (mean area 5 4.8 cm 2 ). Most of the patients did not experience complications. Ectropion occurred in 7 patients. The mean VAS score was 11.6. CONCLUSION An inferiorly based rotation flap yields acceptable outcomes for infraorbital cheek defects and can be considered for defects as large as 5.5 cm. Using pearls for surgical execution presented in this article may allow reconstructive surgeons to include this flap in their repertoire.

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Section: Discussionmentioning

confidence: 92%

Inferiorly Based Rotation Flaps for Infraorbital Cheek Defects

et al. 2021

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“…[12] In addition, the pedicle of this flap should be inferior-based rather than lateral-based to prevent postoperative lid retraction. [11] Postoperative anthropometric measurements of this flap showed that poor design can cause a significantly increased risk of lower lid distortion, and therefore careful design must be performed to apply techniques that prevent lower lid retraction. [12] To prevent cheek sagging and ectropion, suturing the undersurface of the flap to the malar periosteum is strongly recommended.…”

Section: Discussionmentioning

confidence: 99%

Does the optimal layer of the skin include the orbicularis oculi muscle when elevating cheek rotation flap?

Ishii

Takayama

Sakai

et al. 2019

J Cutan Aesthet Surg

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Background: The cheek rotation flap is widely used as an optimal technique for lower eyelid reconstruction; however, the elevation layer of the skin including the orbicularis oculi muscle (OOM) remains unresolved. Materials and Methods: Between February 2006 and October 2012, 11 patients who underwent repair of partial-thickness defects of the lower eyelids using the cheek rotation flap were included in this prospective study. We investigated the influence of elevating the layer of skin including the OOM on the incidence of perioperative complications, operation time, long-term postoperative morphology, and function of the lower eyelid. The layer of flap elevation was deep to the OOM in four patients (deep to OOM cases) and superficial to the OOM in seven (superficial to OOM cases). Results: The superficial to OOM cases had a similar incidence of perioperative complications including flap congestion as the deep to OOM cases. However, the superficial to OOM cases required a significantly longer operation time. Furthermore, lid retraction was found in all of the deep to OOM cases and none of the superficial to OOM cases. In addition, the postoperative results in all the superficial to OOM cases showed satisfactory contours of the lower eyelid without revision surgery. However, many of the deep to OOM cases needed revision surgery to improve lid retraction. Conclusion: The cheek rotation flap should be elevated in superficial to the OOM cases because postoperative lid retraction occurred significantly more in the deep to OOM cases than in the superficial to OOM cases, although elaborate dissection may prolong the operation time.

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“…The cheek is undermined widely in the superficial to midsubcutaneous level to ensure adequate flap mobilization and eliminate tension along closure lines. 4,8,12 The flap is advanced medially to close the defect and one to three sutures are placed from the undersurface of the flap to the periosteum of the ascending process of the maxilla in the nasofacial junction using absorbable 4-0 suture material (Biosyn, glycolide/dioxanone/trimethylene polyester [Medtronic USA, Minneapolis, MN] or Vicryl, polyglactin 910 [Ethicon, Inc., Bridgewater, NJ]). The periosteal suture is placed first to maintain concavity of the nasofacial sulcus, relieve tension along the flap, and eliminate dead space.…”

Section: Techniquementioning

confidence: 99%

“…The periosteal suture is placed first to maintain concavity of the nasofacial sulcus, relieve tension along the flap, and eliminate dead space. 4 Once in place, the flap can be trimmed to allow for approximation of all wound edges. For the reminder of the flap and standing cone defects, absorbable 5-0 polyglactin 910 buried deep dermal sutures are placed to approximate the dermis and absorb maximal tension along the suture line.…”

Section: Techniquementioning

confidence: 99%

“…1 This highly effective and precise technique offers histopathologic tumor margin control while maximizing conservation of healthy tissue. [2][3][4] Roughly 30% of keratinocyte carcinomas develop on the nose, with 24% located on the nasal dorsum and 16% located on the nasal sidewall. 5,6 Nasal reconstruction following MMS can be challenging, given the various concavities and convexities along the nasal surface.…”

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confidence: 99%

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Applying Occam's Razor and Descending the Reconstructive Ladder: The Modified Cheek Advancement Flap for Reconstruction of Nasal Defects

et al. 2022

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INTRODUCTION: Nasal reconstruction has important functional and cosmetic considerations, as proper repair of nasal defects is necessary to maintain function of the nasal airway and to recreate the normal appearance of this central facial structure. Cheek advancement flaps provide matched, mobile and highly vascularized tissue for the reconstruction of nasal defects, allowing for the concealment of incisions within natural creases in a one-stage approach. However, cheek advancement flaps are often underutilized for nasal reconstruction because of their difficulty restoring nasal contour. METHODS: We describe reconstruction of 19 nasal dorsal and sidewall defects 0.8 to 3.0 centimeters (cm) in size. We incorporated a periosteal anchoring suture to maintain/restore nasal contour and additionally removed a half standing cone inferior to the defect to prevent encroachment of the nasal ala or alar crease. All patients were evaluated at least 3 months post-operatively. RESULTS: In all patients, we were able to restore concavity of the nasofacial sulcus, preserve the biconvex nasal tips, prevent alar flaring and retraction and conserve the alar groove. All patients had excellent functional and cosmetic outcomes. CONCLUSION: We believe this modified cheek advancement flap provides functionally and aesthetically superior results and can be considered as a first-line approach for repair of nasal dorsal and sidewall defects in sub selected patients.

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An Inferiorly Based Rotation Flap for Defects Involving the Lower Eyelid and Medial Cheek

Cited by 11 publications

References 13 publications

Inferiorly Based Rotation Flaps for Infraorbital Cheek Defects

Inferiorly Based Rotation Flaps for Infraorbital Cheek Defects

Does the optimal layer of the skin include the orbicularis oculi muscle when elevating cheek rotation flap?

Applying Occam's Razor and Descending the Reconstructive Ladder: The Modified Cheek Advancement Flap for Reconstruction of Nasal Defects

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