Repair of Facial Scars by the Free Expanded Deltopectoral Flap

Song, Baoqiang; Zhao, Jianhui; Guo, Shuzhong; Yi, Chenggang; Liu, Chaohua; He, Lin; Li, Yang; Shao, Jianchuan; Xi, Zhang

doi:10.1097/prs.0b013e3182789c02

Cited by 19 publications

(15 citation statements)

References 10 publications

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“…One of the most commonly used flaps around the anterior chest region has been historically represented by the deltopectoral flap, and extensive pioneering works have documented its use in the treatment of cervicofacial defects . However, some disadvantages have limited this flap versatility over practice and have concurred to make this flap being considered almost outdated and progressively less used for oral cavity reconstruction according to modern reconstructive principles: short vascular pedicle with limited arch of rotation; long distance from the pivot point to the receiving site; time necessary (usually 3 weeks) to vascular delay; two‐step reconstruction required for challenging reconstructions; mandatory position of patients; sporadic need of a skin graft to cover the donor site, especially if the flap is harvested out of its angiosome .…”

Section: Discussionmentioning

confidence: 99%

Subclavicular flap: A valid reconstructive option among anterior chest flaps in oral cancer patients

Mannelli

Agostini

Arcuri

et al. 2019

Journal of Surgical Oncology

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Background: The subclavicular pedicled flap is based on the thoracic branch of the supraclavicular artery, and it represents a versatile reconstructive option for lowmiddle third face defects. Since its use in head and neck surgical oncology has not been popularized yet, we propose its application for oral cavity reconstruction after cancer resection by showing favorable results.Methods: Eighteen subclavicular pedicled flaps were used to treat intraoral defects after oral squamous-cell cancer resection between June 2015 and December 2018.Tumor dissection type, complications, donor and reconstructed area results, and functional and aesthetic outcomes were assessed. Results: No major complications were observed and all of the flaps survived. Adjuvant therapy was administered without delay when needed, and all of the patients had normal functional outcomes and good aesthetic results. Conclusions: The subclavicular flap is an excellent choice for the reconstruction of oral cavity defects. Selection of patients should exclude positive lower-third neck node and include appropriate informed consent for women due to the possibility of deformity of the breast. In our opinion, this flap has the potential for common application given its consistent anatomy and donor site advantages, including long pedicle, high pivot point, and relatively unlimited flap width. K E Y W O R D S oral cancer, pedicled flap, reconstruction, thoracic branch of supraclavicular artery 1 | INTRODUCTION Deformed appearance and impaired function in the oral cavity due to tumor resection necessitate appropriate and high-quality reconstructive tissue. Among multiple reconstructive options, microsurgical techniques might be time-consuming and costly, and the results are not always satisfactory, even though free flaps remain the first choice for vessel-depleted neck and osseous reconstruction, as well as for through-and-through defects. 1 Consequently, the adjacent pedicled local flaps (eg pectoralis major, submental island, and deltopectoral flaps) are excellent alternative reconstructive options due to their fair color and contour, even though they are usually bulky. In this setting, the chest region seems to be an ideal donor site, with abundant vessel networks that can guarantee a high reconstructive success rate 2-4 and where, depending on the skin paddle design, differing skin thicknesses are available. In many people, the skin is not hair-bearing and the color match is ideal for cervicofacial skin. Various flaps have been explored, 5 including muscle-sparing thoracoacromial artery perforator flaps, 6 propeller flaps, 7 and supraclavicular flaps, 8 but the short length of the pedicle, the long distance Meeting: This paper was presented as oral presentation at the 24th Congress of the European Association for Cranio Maxillo Facial Surgery, 18 to 21 September 2018, in Munich, Germany.

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Section: Discussionmentioning

confidence: 99%

Subclavicular flap: A valid reconstructive option among anterior chest flaps in oral cancer patients

Mannelli

Agostini

Arcuri

et al. 2019

Journal of Surgical Oncology

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“…Since the DP flap was first introduced by Bakamjian 1 in 1965, many authors have reported various reconstructions using the flap, 1 – 5 of which the donor site was mostly reconstructed using skin grafting. 1 , 2 We have also performed anterior neck region reconstruction using the DP flap.…”

Section: Discussionmentioning

confidence: 99%

The Reconstruction of the Donor Site of DP Flap Using Thoracodorsal Artery Perforator Flap

Okochi

Sakaba

2017

Plastic and Reconstructive Surgery - Global Open

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Summary:We performed a new procedure for reconstruction of donor site of a deltopectoral (DP) flap. A 58-year-old man presented with a wide subcutaneous abscess, which was caused by acute mandibular osteomyelitis due to dental caries. On admission, the patient received a neck incision for drainage. However, necrosis of the neck skin was observed after drainage. The patient had an 8 × 10 cm skin and soft-tissue defect, which we covered with a DP flap (15 × 7 cm). The DP flap donor site was reconstructed using a 16 × 8 cm pedicled thoracodorsal artery perforator (TDAP) flap. There was no flap necrosis, abscess formation, or scar contracture of the DP region. Debulking of the TDAP flap was not required. The pedicled TDAP flap is useful for the reconstruction of the donor site of DP flap. In this report, we describe our operative procedure.

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“…Because of a good colour and texture match, pre-expanded local skin flaps would be advantageous especially in head and neck reconstruction 11,12 . Pre-expanded deltopectoral flap, subclavicular and supraclavicular flaps are able to obtain contour and colour match to the neck [13][14][15] . Major disadvantage of these flaps is the morbidity of the donor site that always leads to a hypertrophic scar.…”

Section: Discussionmentioning

confidence: 99%

Boyun defektlerinin preekspanse oksipito-serviko-dorsal ada flepleri ile onarımı

Eser¹,

Olguner²,

Sabancıoğularından³

et al. 2016

Cukurova Medical Journal (Çukurova Üniversitesi Tıp Fakültesi Dergisi)

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ÖzPurpose: Neck defects usually occur after burn contracture release and benign or malignant neck tumor excisions. Frequently used neck skin reconstruction methods are skin grafting, Z-Plasties, skin pedicled or perforator flaps, and free flaps. Pre-expanded perforator skin flaps are useful options for skin defect reconstructions. Pre-expansion of the skin flap provides more tissue for the reconstruction and donor area closure. Additionally, defect reconstructions used by adjacent skin maintain a good tissue colour and texture match with the defect. Material and Methods: In this study, 8 patients (neck burn contracture release (n=7) and congenital giant hairy nevus excision (n=1)) whose neck defects were reconstructed with 11 pre-expanded occipito-cervicodorsal perforator island flaps were evaluated. The maximum and minimum flap sizes were 9x23 cm and 5x13 cm respectively. Mean age of the patients was 15.8 and mean expansion time was 11.5 weeks. Results: Mean follow-up time was 27.8 months. We encountered an expander exposition in one case and 50% flap necrosis in another case. Aesthetic and functional improvement was observed in all patients. Conclusion: The pre-expanded occipito-cervico-dorsal perforator island flap is useful in moderate sized lateral neck defects. The aforementioned flap provides good tissue compliance and colour with neck and minimal donor area morbidity. It is a new useful reconstructive method in patients with lateral neck defects, who have a healthy cervico-dorsal skin and do not have useful ventral skin. Amaç: Boyun cildi defektleri genellikle kontraktür sebestleştirilmesi veya malign/benign tümör eksizyonu sonrası meydana gelir. Sık kullanılan boyun cilt rekonstrüksiyon yöntemleri Z-plastiler, cilt pediküllü veya perforatör flepler ve serbest fleplerdir. Bunlara ek olarak son zamanlarda pre-ekspanse perforator cilt flepleri cilt defekt rekonstrüksiyonlarında sıkça kullanılmaktadır. Cilt fleplerinin ekspansiyonu rekonstrüksiyon ve donor alan onarımı için daha fazla doku sağlar. Ayrıca defektlerin yakın doku ile rekonstrüksiyonu, renk ve yapı uyumu açısından iyi sonuçlar verir. Gereç ve Yöntem: Bu çalışmada 7'si boyun kontraktür açılması sonrası ve 1'i konjenital dev kıllı nevus eksizyonu olmak üzere boyunda cilt defekti olan 8 hasta değerlendirildi. Tüm defektlere toplam 11 adet preekspanse oksipito-serviko-dorsal ada flebi ile onarım uygulandı. En geniş flep boyutu 9x23 cm iken en küçük flep boyutu 5x13 cm idi. Ortalama hasta yaşı 15.8 idi ve ortalama ekspansiyon zamanı 11.5 hafta idi. Bulgular: Hastalar ortalama 27,8 ay takip edildi. bir hastada doku genişletici ekspozisyonu oluşurken başka bir hastada %50 flep nekrozu görüldü. Tüm hastalarda estetik ve fonksiyonel sonuçlar kabul edilebilir seviyelerdeydi. Sonuç: Preekspanse oksipito-serviko-dorsal flep, orta büyüklükteki boyun defektlerinde kullanılabilecek uygun bir rekonstrüksiyon seçeneğidir. Tanımlanan flep, özellikle ön servikal ve torakal cildi uygun olmayan ve dorsal serviko-dorsal cildi sağlam olan hastalarda uygulanabilecek ye...

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Repair of Facial Scars by the Free Expanded Deltopectoral Flap

Abstract: Therapeutic, V.

Cited by 19 publications

References 10 publications

Subclavicular flap: A valid reconstructive option among anterior chest flaps in oral cancer patients

Subclavicular flap: A valid reconstructive option among anterior chest flaps in oral cancer patients

The Reconstruction of the Donor Site of DP Flap Using Thoracodorsal Artery Perforator Flap

Boyun defektlerinin preekspanse oksipito-serviko-dorsal ada flepleri ile onarımı

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