Cervicofacial Defect Reconstruction Using the Pre-Expanded Medial Arm Flap Without Immobilization of the Upper Extremity

Abstract

The medial arm flap has multiple advantages when used for cervicofacial defect reconstruction but remains underused. The main drawback of the medial arm flap is that the patient must maintain the passive immobilized posture before the pedicle division. This clinical study aims to introduce a reconstructive method for cervicofacial defects using the medial arm flap without the immobilization of the upper extremity. This retrospective study was performed with data from 14 patients requiring pre-expanded medial arm flaps to reconstruct cervicofacial defects. Indocyanine green (ICG) angiography was used to detect perforators and evaluate the flap perfusion; all the flaps underwent pre-transfer tissue expansion. A total of 15 full-length medial arm flaps were used. All the perforators identified by ICG angiography were directly visualized during flap elevation. In four cases, poor perfusion areas in the flaps were noted by intraoperative ICG angiography. Combined with the clinical observation, parts with poor perfusion were resected. The average flap size was 203.9 AE 75.2 cm 2 and ranged 20 to 28 cm in length after tissue expansion. The medial arm donor sites were closed directly or using another flap. All flaps survived completely. The patients were followed-up for 1 to 22 months. All patients and their family members were satisfied with the outcomes. Cervicofacial defect reconstruction using a medial arm flap with the aid of tissue expansion and ICG angiography can provide sufficient tissue for defect resurfacing and also eliminate the necessity of the immobilization of the upper extremity during surgery.

Sizeable Facial and Cervical Defect Repair using a Medial Arm Flap Combined With the Tissue Expansion Technique: Clinical Applications and Fifteen-year Follow-up

“…Another study proposed lengthening the pedicle by including the perforator within the pedicle in the second stage, which can greatly improve the range of motion of the patients’ shoulder and alleviate discomfort 7 . With the aid of indocyanine green angiography (ICGA) for evaluating flap perfusion, the time before pedicle division can be shortened, which, in turn, helps reduce the passive immobilization time 22 …”

“…7 With the aid of indocyanine green angiography (ICGA) for evaluating flap perfusion, the time before pedicle division can be shortened, which, in turn, helps reduce the passive immobilization time. 22…”

Hair-Bearing Expanded Scalp Flap for Total Beard Reconstruction in Patients With Chin and Submental Postburn Scars

“…Tissue expansion can harvest enough “extra skin tissue” for tissue repair 7. The pre-expanded visor scalp flap was first reported for beard reconstruction in 1993 by Datubo-Brown, and recently described for reconstruction of upper and lower lip defects 5,8.…”

“…6 Tissue expansion can harvest enough "extra skin tissue" for tissue repair. 7 The pre-expanded visor scalp flap was first reported for beard reconstruction in 1993 by Datubo-Brown, and recently described for reconstruction of upper and lower lip defects. 5,8 Despite the expanded hair-bearing scalp flap seems to be an excellent solution for beard reconstruction, the complicated technical requirements and occasionally flap necrosis limit its applications.…”