Free Style Perforator Flaps for Aesthetic Facial Reconstruction

Abstract

BACKGROUND Functional and cosmetic outcomes affect reconstruction of the face more than any region of the body. To use a predetermined perforator flap freely designed allowing a wide range of movement and manipulation can give us an optimum outcome. We present our clinical experience with free style facial perforator flaps, surgical technique, and complications. METHODS Thirty patients with post-tumor resection of the face were reconstructed with free style local perforator flaps between January 2014 and November 2016. Doppler was used to identify the perforator vessels preoperatively. RESULTS Twenty-two clinical cases had no complications. Four had venous congestion that resolved spontaneously, three had a distal 1/3 superficial necrosis, and one suffered from hematoma. CONCLUSION Freestyle perforator flaps were applied to get better cosmetic facial reconstruction, allowing one stage procedure and decreasing donor site morbidity. Modern anatomical understanding, good planning, and meticulous surgical technique can affect clinical results.

Nasolabial Flap in the Management of Oral Sub Mucous Fibrosis: A Series of Cases

“…15,16,17 The nasolabial flap can be based superiorly or inferiorly depending on the vascularity required and is suitable for reconstructing defects in the cheek, nose, lips, and intraoral region. [18][19][20] The current case study aimed to evaluate the outcomes of the nasolabial flap in the surgical treatment of oral submucous fibrosis.…”

“…23,24 Superiorly based flaps are suitable for reconstructing nasal, lower eyelid, and cheek abnormalities, while inferiorly based flaps are ideal for repairing lip, oral commissure, and anterior oral cavity defects. [18][19][20]25 During the procedure, an incision line closely following the nasofacial fold was made using a Bard Parker blade #15. 24 The width of the flap base, similar to the study by Qayyum et al was approximately 1.5 to 2.5 cm to ensure an adequate blood supply.…”

“…The proximity of the defect and the ease of closing the donor site are additional advantages of using the nasolabial flap, with the resulting extraoral scars being concealed within the nasolabial fold. 18,19 Comparative studies by Pandey et al and Patil et al have shown that the nasolabial flap, with its good patient acceptance, rapid epithelialization, and minimal morbidity at the donor site, yields favorable results similar to buccal fat pad transplantation in terms of intra-and postoperative complications. 12,24 Alternative reconstruction methods such as split thickness skin grafts, palatal island flaps, and tongue flaps are associated with significant postoperative complications, including raphe development, fibrosis, and postoperative dysphagia or aspiration risk.…”

Facial Defect Repair Using a Flap Based on the Superficial Temporal Artery

“…We determined that a distant pedicle flap based on the inner transverse perforator of the ascending frontal branch of the superficial temporal artery (STA) would not only reduce the midfacial advanced flap incision but would also reduce the risk of complications such as hemorrhaging and pain at the wound site, which are increased by the chewing motions performed while eating. 16 …”

“…We determined that a distant pedicle flap based on the inner transverse perforator of the ascending frontal branch of the superficial temporal artery (STA) would not only reduce the midfacial advanced flap incision but would also reduce the risk of complications such as hemorrhaging and pain at the wound site, which are increased by the chewing motions performed while eating. 16 Anjun Liu, BD* Xianlin Su, MD* Yang Jiao, BD* Ping Yang, BD* Damao Dai, MD † Jianyang Xu, MD* Background: Although a local flap repair is optimal for facial defects, an extra flap or split-thickness skin graft may be needed if a sufficient local flap area is not available. In this study, we developed a distant axial pedicle flap procedure based on the inner transverse perforator of the ascending frontal branch of the superficial temporal artery to repair facial defects while meeting patients' requirements for a like-for-like tissue reconstructive outcome.…”