New Buccinator Myomucosal Island Flap: Anatomic Study and Clinical Application

Abstract

The aesthetic surgeon may occasionally be consulted by a patient who wishes to discuss what can be done for the scars of self-inflicted wounds on the forearms. These scars are popularly referred to as "hesitation marks" or "suicide gestures." Unlike patients suffering from factitial ulcers or Münchhausen syndrome, these patients will admit to the physician that the scars are the result of self-inflicted wounds. These scars often consist of multiple, parallel, white lines extending up and down the forearms (usually volar surface), with more on the nondominant side. Although the pattern of these scars is apparently what drives these patients to the aesthetic surgeon for relief (because even lay people identify these scars as self-inflicted suicide marks), the authors propose a new and deeper motivation for surgery. Recent experiences with three of these patients resulted in an epiphany that prompted this report. Once the symbolic meaning of these scars was broached, a torrent of thoughts and theories followed. This article will recount these three cases and present a central thesis for this type of self-inflicted injury. A proposal for the proper surgical treatment of this condition will be offered. Uniquely, two of the patients will relate their own stories and propose guidelines and warnings for the aesthetic surgeon.

Functional Anastomotic Relationship between the Supratrochlear and Facial Arteries: An Anatomical Study

“…16,23,24,[37][38][39] Although these anatomical variations occur, there appears to be equivalent variations within the vascular arcade of the paranasal region, as demonstrated in this study and the previously mentioned anatomical studies, compensating for a lack of direct supply by the angular artery. For example, Figure 7 demonstrates an anastomotic relationship between the infraorbital and angular artery.…”

Six Years Clinical Experience With the Dorsally Pedicled Buccal Musculomucosal Flap

“…[13][14][15][16][17][18][19][20][21][22][23][24][25][26][33][34][35]37 Rayner, in 1984, 17 mentioned several possible applications yet to be explored. Tezel et al 33 have restricted the use of CBMMF to the lower vermillion, gingivobuccal sulcus, mouth floor, and anterior maxillary defect reconstruction.…”

“…Most axial flaps require extraoral incisions and occasionally bite blocks if the occlusion of dentate patients is crossed. [21][22][23][24][25][26] Buccal fat pad served in defect reconstruction of the buccal planum and dorsal maxilla. 27 Uncomplicated healing was reported within 3 to 4 weeks, even if left uncovered to epithelialize and no endangerment of the buccal contour was reported.…”

Three-dimensional primary reconstruction of anterior mouth floor and ventral tongue using the ‘trilobed’ buccinator myomucosal island flap

“…The ideal reconstruction should be carried out with same or similar type of tissue, and cheek axial myomucosal flaps based on the facial and internal maxillary arteries seem to provide this 1,5,9,10 .…”

“…PRIBAZ et al 5 introduced the facial artery myomucosal (FAMM) flap, another axial flap pedicled on the facial artery, to reconstruct palatal, tongue, mouth floor and lip defects. ZHAO et al 9 described two patterns of buccinator myomucosal island flaps supplied by the buccal branches of the internal maxillary artery and by the buccal branches of the facial artery, these are the buccinator myomucosal neurovascular island flap (posteriorly based) and the buccinator myomucosal reversed flow arterial island flap (superiorly based). ZHAO et al 10 were the first to use the buccinator myomucosal island flap based on the facial artery for partial tongue reconstruction.…”