Esthetic Repair of Facial Skin Defect After Resection of Malignant Tumor With Lateral Maxillocervical-Island Fasciocutaneous Flap

Abstract

excision of the lesion was performed. Tumor-free margins were established after wide excision which included the underlying perichondrium, resulting in a defect of 2.0 x 1.0 cm 2 with exposed bare cartilage.Turnover flap coverage was planned, and an extension skin incision 2 cm in length was made on the caudal portion of the defect area where the cephalic portion of earlobe is located (Fig. 1B). After the extension incision, a flap was designed and dissection was carried out through the subperichondrial layer on the caudal antihelix and antitragus of the defect. The dissection was continued to the earlobe in the subcutaneous plane. Care was taken to preserve a ''bridge area'' 1 Â 1 cm 2 in size proximal to the defect area. An adipoperichondrial flap of about 3 Â 1 cm 2 was raised and turned over to cover the exposed cartilage area (Fig. 1B, C). The viability of the flap was confirmed based on its color and marginal bleeding. After fixation of the flap with 6-0 Vicryl sutures to the marginal remnant perichondrium, the defect area was covered by a fullthickness skin graft, followed by tie-over bolster dressing (Fig. 1D).The skin graft took well and no complication was observed for 1 year of follow-up (Fig. 1E). There was no aesthetic deformity of the auricle, due to maintenance of the cartilage framework. DISCUSSIONAdler et al 4 introduced a V-Y advancement flap from skin of the antihelix for coverage of antihelical defect with exposed cartilage. Triangle-shaped flaps on the upper and lower margins of the defect were undermined until the flaps were based only on central subcutaneous tissues and advanced toward the defect area for closure of the wound. The flaps are random flaps and the feeding vessel is uncertain. This procedure is only possible for small defects less than 1 cm in diameter. The tension on flap margins can cause partial necrosis, and forced advancement of flaps can cause disfiguration of the ear.Other options for closure of full-thickness antihelical defects involve healing by secondary intention after making holes in the cartilage or excising the cartilage. 2 However, secondary healing requires a long time for complete coverage.Beusters-Stefanelli et al 3 reported a postauricular helix-based adipodermal pedicle turnover (PHAT) flap for defects of the antihelix, which is a local pedicled skin flap taken from the posterior surface of the ear. This is a single-stage technique with reliable vascular pedicle for antihelical defects but retroauricular sulcus loss and distortion of the ear shape can occur in cases with a large retroauricular donor site defect.According to the anatomical study by Zilinsky et al, 5 2 major arteries provide vascular supply to the outer ear, that is, the superficial temporal artery and the posterior auricular artery. The superficial temporal artery has three anterior branches (superior, middle, and inferior), with the middle and inferior anterior auricular artery contributing to the capillary network of the earlobe. The posterior auricular artery gives off two to four perfora...

Clinical Effectiveness of Free Upper Arm Medial Flap in Repairing Skin and Soft Tissue Defects of the Dorsum of the Hand

“…At present, common donor sites for the skin flaps include the dorsum of the foot, the anterolateral thigh, and the lateral arm. However, the skin flaps are more bloated, and the survival rate of the skin flaps after repair is not impressive, which in turn poses a negative impact on both the recipient and the donor sites [ 4 – 6 ]. It has been reported that flaps from the medial aspect of the upper arm can be used to repair SST defects of the opisthenar, with desirable effectiveness [ 7 ].…”

Surgical Reconstruction of a Large Defect after Excision of Infiltrative Squamous Cell Carcinoma in the Scalp and Occipital Region: A Case Report

“…The incidence of scalp tumors is on the rise, in contrast to skin tumors in other areas. Only a small percentage (1% to 2%) of scalp tumors are malignant, and intracranial invasion by SCC is rare [9,10] . However, such an invasion is indicative of a poor prognosis.…”