Modified Cervicofacial Flap for Large Cheek Defect Reconstruction under Local Anesthesia

Abstract

The cervicofacial flap was first described in 1969. For the past several years, it has been the flap of choice for the reconstruction of facial defects especially cheek defects. In recent years, with the advent of microvascular free flap tissue transfer, the use of a cervicofacial flap has been sparse. This article highlights the importance and application of locoregional flaps such as a cervicofacial flap in the reconstruction of soft tissue defects on a face. This case was unique from the reconstruction point of view. An 81-year-old patient presented to us with a long standing ulcerated growth in his left cheek which was neglected due to lack of symptoms and his poor financial condition. Clinically, the extent was defined from the suborbital skin region till the mid cheek region and medially from the lateral nasal crease up to the cheek prominence area. An initial biopsy suggested basal cell carcinoma. The lesion was excised, and a 4.5×5.5 cm defect was reconstructed using a modified “cervicofacial” flap under local anesthesia. Our experience shows that this technique is a reliable, easy to harvest flap with good outcomes. Moreover, it can be utilized in those candidates not suitable for a free flap procedure under general anesthesia.

Cervicofacial flap for reconstruction of squamous cell carcinoma on the right cheek: A case report

“…It has been reported that the method was performed under local anesthesia. 7 In our case, as the zygomatic bone resection was relatively small, satisfactory results were obtained using cervicofacial flap. However, in cases where the zygomatic bone needs to be largely resected, it is considered necessary to perform microvascular free flap transfer, such as an osteocutaneous scapular flap.…”

“…The method does not require special techniques, such as vascular anastomosis, and can shorten the surgery time. It has been reported that the method was performed under local anesthesia 7 . In our case, as the zygomatic bone resection was relatively small, satisfactory results were obtained using cervicofacial flap.…”

Versatility of cervicofacial flap in management of cutaneous cheek defects post tumour excision: a report of two cases

“…The modified cervicofacial flaps was used by Kaplan in 1978 for coverage of defects following removal of cancers of the head and neck. 2 This flap had undergone modifications based on the plane of dissection either superficial or deep to SMAS 3 . The supra- SMAS flaps depend on the rich subdermal plexus of vessels, and the infra- SMAS flaps rely upon more reliable large perforator branches from facial and transverse facial arteries.…”

“…Hence, such patients will benefit from locoregional flaps such as cervicofacial flap that can be done over a reduced operating time and considerable postoperative recovery time. This flap technique had gone through various modifications since its introduction by Esser et al in 1918 2 The modifications are in relation to superficial musculo-aponeurotic system (SMAS) plane dissection whether superficial or deep to it 3 . It has robust random blood supply and it is usually inferiorly based.…”