The full-thickness retroangular flap

Various Types of Facial-Angular Artery-Based Flaps for Reconstructing Oral and Maxillofacial Defects Following Cancer Ablation

BACKGROUND

The flap based on the facial-angular vessels (FAVs) has several names and cannot capture the hemodynamics.

AIMS

This study was performed to assess the reliability of various types of flaps based on the FAVs for reconstructing oral and maxillofacial defects following cancer ablation.

PATIENTS AND METHODS

Forty-three oral and maxillofacial defects were reconstructed with facial-angular artery island flaps (FAAIF, n=14), including V-Y advancement-type and rotation-type flaps based on FAVs and reverse-flow FAAIFs (R-FAAIF, n=29), including ipsilateral, contralateral rotation, full-thickness, and folded types, based on distal FAVs following cancer ablation. The patients (25 males and 18 females) ranged in age from 18 to 82 years. The lesions included basal cell carcinoma (n=26), squamous cell carcinoma (n=8), adenoid cystic carcinoma (n=3), mucoepidermoid carcinoma (n=3), verrucous carcinoma (n=2), and nodular melanoma (n=1). The tumors were classified as clinical stage I to III in 12, 25, and 6 cases, respectively. Lesions were observed in orbital (n=4), infraorbital (n=14), glabellar (n=2), nasal (n=4), cheek (n=10), upper lip (n=3), palate (n=4), and lower gingival (n=2) regions. The defects ranged in size from 2.0×2.5 to 5.0×12.0 cm. The skin paddle ranged in size from 1.5×3.0 to 4.0×12.0 cm.

RESULTS

There was 1 flap failure, resulting in a flap success rate of 97.7%. Complications, including hematoma, infection, wound dehiscence, and fistula, occurred in 15 (34.9%) patients. Limitations of mouth opening and ectropion occurred in 12 (28.0%) patients. The esthetic outcomes were satisfactory in 36 (83.7%) patients but were not significantly different between the FAAIF and R-FAAIF groups. The patients were followed up for 6 to 60 months. At the time of the last follow-up, 27 (62.8%) patients were alive with no disease, 9 (20.9%) were alive with disease, and 7 (16.3%) had died due to their disease. There was no significant survival difference between the 2 groups.

CONCLUSIONS

Various types of FAV-based flaps are valuable reconstructive options for the treatment of oral and maxillofacial defects following clinical stage I-III cancer ablation.

The place of nasolabial flap in orofacial reconstruction: A review

BACKGROUND

The use of Nasolabial flap (NLF) to reconstruct orofacial soft tissue defects is one of the oldest methods for reconstruction in the medical literature. Despite widespread use of this invaluable flap, there are still controversies over the terms used for the description of this flap.

MATERIALS AND METHODS

A search was run in PubMed for articles in English language on nasolabial flap in oral cavity/facial reconstruction, between 1960 and 2016. Inclusion criteria was case series that focused on the anatomy, flap design, blood supply, composition, flap motion, and the reconstructed area and donor site complications.

RESULTS

560 articles were found in PubMed search for nasolabial flap (between 1960 and 2016). 84 articles with case series structure and available full text were included. The results of the search in this topic for anatomy, flap design, blood supply,NLF composition, flap motion, reconstructed area and donor site morbidity are presented.

CONCLUSION

Nasolabial flap is an old flap for reconstructive purposes. Over time different modifications have been introduced to expand its usage. Clear definition of the terms used with this flap is given.

Indications for, and limitations of, the retroangular flap in facial reconstruction according to its vascular mapping

We have used the retroangular flap for the reconstruction of facial defects after excision of tumours. Important variables such as vascular mapping, type of anaesthesia, duration of stay in hospital, and the diagnosis and treatment of complications were taken into account in assessing its effectiveness. We studied 187 patients, 103 men and 84 women, who were treated with the retroangular flap, and the morphological and cosmetic results analysed. There are many vascular variations of the flap The patients were followed up for a median of 12 (range 12-125) years and their reconstructions were successful. The technique can be considered as one of first methods of choice for the reconstruction of cutaneous defects of the middle third of the face.

Angular vessels as a new vascular pedicle of an island nasal chondromucosal flap: Anatomical study and clinical application

Successful eyelid reconstructions have been reported when using an axial nasal chondromucosal flap based on the dorsal nasal artery. The present study aimed to present a detailed anatomical description of the blood supply of the lateral nasal region and the angular artery, in order to propose the angular vessels as a new vascular pedicle for the island nasal chondromucosal flap. A total of 11 cadavers (22 hemi-faces) were examined. Observations with regard to the origin, course and distribution patterns of the angular artery were recorded. Based on the anatomical study findings, the angular vessels were proposed as a vascular source for the island nasal chondromucosal flap. Observations with regard to the varying origins of the angular artery were categorized into four types. The course of the angular artery along the nasojugal fold was constant. The angular artery branched off into the upper two-thirds of the lateral nasal region and anastomosed with the other vascular branches on the nasal dorsum. Clinically, reconstruction of a full-thickness defect of the lower eyelid was successfully performed by using this composite flap based on the angular vessels and an adjacent orbicularis oculi myocutaneous flap. Satisfactory esthetic outcomes were obtained for the donor and recipient sites. The angular artery is a good vascular source for an island nasal chondromucosal flap. The flap may be created safely and successfully in clinic. Island nasal chondromucosal flaps and nasolabial groove skin flaps based on the angular vessels may be designed simultaneously for use on full-thickness defects of the eyelid.

Complications after nasal skin repair with local flaps and full-thickness skin grafts and implications of patients' contentment

PURPOSE

The range of complications after plastic surgical repair of nasal skin defects is not clearly known. The aim of this study was to identify complications after reconstruction of nasal skin defects to determine what typical complications occur after standard surgical options including full-thickness skin graft (FTSG) and local flap plastics (LFP).

MATERIALS AND METHODS

In 210 patients with defects of the nasal tip, the nasal ala or dorsum of the nose (average diameter 1.1 +/- 0.3 cm) surgical skin repair was performed with LFP or FTSG. Complications within 6 months after surgery were recorded.

RESULTS

Some 41 patients (19.5%) suffered complications; there was no significant difference in total complication rate between LFP (20.5%) and FTSG (18.3%). However, FTSG patients had significantly more infections postoperatively than LFP patients (5.4% vs. 2.6%). LFP patients presented a significantly higher rate of wound or suture dehiscence (FTSG 2.2%, LFP 5.9%). FTSG patients exhibited a significantly higher rate of partial or complete loss (total rate FTSG 8.5%, LFP 5.2%). The LFP technique led to significantly more aesthetic deficits (FTSG 2.1%, LFP 6.8%).

CONCLUSIONS

LFP showed advantages with regard to infection and loss rates but with a higher rate of aesthetic deficits compared to FTSG. It remains an individual decision as to which procedure is used to repair defects of the nose, depending on patient and surgical variables.

Three-dimensional nasal reconstruction using a prefabricated forehead flap: case report

Surgical treatment is extremely difficult with the combined defects of skin, cartilage, and nasal mucosa. Besides efforts geared toward ascertaining the best aesthetic outcome, an important concern is restoring normal nasal function. This can be achieved only by providing sufficiently and anatomically adapted cartilage and bone support, followed by covering the inner part using tissue closely resembling mucosa and the outer part using skin compatible with the surrounding skin. The surgical technique for three-dimensional nasal reconstruction in the first session of this study involved placing a silicon sheet between the skin and galea, which allowed two separate flaps to be obtained for the next session without vascular damage. For the epithelialization of the defect on the nasal surface, the lower surface of the galea was prefabricated with a thin skin graft obtained from the thigh. In this way, nasal mucosa cover was ensured. The expander placed under all these structures thinned them down to a thickness close to that of nasal skin and mucosa and also enabled primary closure of the donor area. Thus, the defect that emerged during the second session in cartilage framework was repaired by cartilage grafts taken from the nasal septum. The mucosal surface and skin part then could be closed with two separate flaps. The forehead flap used in this technique enabled production of an aesthetically and functionally satisfactory outcome by providing an anatomically sufficient amount of nasal skin and nasal mucosa for whole-layer wide nasal defects in only three sessions without necessitating an additional flap.

Microsurgical reconstruction of the nasal lining

BACKGROUND

Reconstruction of isolated nasal lining defects can be extraordinarily daunting. This report defines the uniqueness of the surgical challenges inherent to reconstruction of the nasal lining and overviews the authors' approach to management.

METHODS

A retrospective review was performed of 11 consecutive patients presenting for reconstruction of the nasal lining alone during the period from October of 1996 through March of 2003. There were four men and seven women with an average age of 49.2 years. The average follow-up was 4.2 years.

RESULTS

Five patients required reconstruction of the total nasal lining (floor, columella, vestibule), and the remaining reconstructions involved subtotal components. Coincidental necrosis of the nasal lining during total/subtotal nasal reconstruction was the most common cause. A single microsurgical free flap was used in eight patients (six radial forearm flaps). Three patients required two free flaps. There were no flap failures. Thirteen of 14 free flaps healed primarily. Dehiscence of the flap/nasal septal juncture occurred in one cocaine-injured nose. Ten of 11 patients demonstrated patent, functional nasal airways postoperatively.

CONCLUSIONS

Reconstruction of the nasal lining, alone, is a very challenging endeavor that demands careful surgical planning and precise technical execution. The use of microsurgical transfer for these defects allows considerable latitude for duplication of the missing complex three-dimensional anatomy and avoids sullying the adjacent facial soft tissues. Because of the adverse condition of the local tissues, the majority of these cases could not have been brought to a successful conclusion without the use of free tissue transfer, and this is particularly relevant in the cocaine-injured nose.

The retroangular flap used in the surgery of nasal tip defects

BACKGROUND

The treatment of large, deep, postsurgical nasal tip defects presents a serious problem for skin surgeons and is generally dealt with by using complex flaps or skin grafts.

OBJECTIVE

The objective was to present the retroangular flap, a procedure that has only recently been described in literature.

METHODS

The retroangular flap technique is based on inverting the blood flow in the angular artery, a vessel that runs along the nasal groove just below the surface of the skin.

RESULTS

The retroangular flap is a single-step, easily performed, procedure that is usually carried out under local anesthesia.

CONCLUSION

This technique can be used for the treatment of nasal tip defects and is a useful resource for skin surgeons.