Prefabricated Expanded Flap Combined With Expanded Scalp Flap for Total Face Resurfacing

Abstract

Reconstruction of total facial deformities and defects has been a major challenge of reconstructive surgery. Allotransplantation is limited by the number of donors and the need for life-long immunosuppression. Autotransplantation, where multiple autogenous tissue grafts from various donor sites are used to repair facial defects, inevitably leaves conspicuous patchwork scars. A prefabricated monoblock flap, although the preferred treatment modality, is limited by insufficient blood supply and the large size of the flap. In the Journal of Craniofacial Surgery (2014;25:21–25), Li et al applied the technique of flap prefabrication and stem cell–assisted tissue expansion to reconstruct total facial injuries, but the operations were complicated and the final expanded flap area was also uncertain. This article introduces an approach to reconstruct total facial injuries with a prefabricated expanded thoracic flap combined with an expanded scalp flap (called combined flaps), which not only solves the limitations of blood supply and expanded volume but also reduces patchwork scars. The approach is a simple, feasible, and effective surgical method for total face resurfacing.

Closure of Giant Dorsal Lumbosacral Myelomeningocele in Children Using Double Expanded Flaps: A Case Report and Literature Review

“…4 The fat provides a source for mesenchymal stem cells, which may improve results in addition to acting as a barrier membrane. 1,3 The control group results had 9 successful cases out of 20; which, is considered comparable and close to values achieved in previous studies as Dissaux et al 5 results Found 46.2% bone fill and 53.3% bone height in conventionally treated groups.The results showed that the addition of dermal fat graft as a barrier membrane was successful significantly in reducing the incidence of dehiscence in the study group compared with the control group in agreement with de Castro et al 6 The dermal fat graft was successful in reducing the graft loss in the study compared with the control in agreement with Khojasteh et al 1,3 The addition of dermal fat was successful in improving results and decreasing the incidence of fistula and dehiscence and achieving a higher bone fill. However, other adjunctive agents such as Liu et al 7 who used recombinant human bone morphogenic protein-2 in the treatment of alveolar clefts and had comparable results to our study, Rao et al 8 used injectable and advanced platelet-rich fibrin in secondary alveolar bone grafting for cleft alveolus in unilateral cleft lip and found highly successful improvement in Bergland scale of study group compared with control, Xiao et al 9 who used guided bone regeneration combined with ACG found also a significant decrease in bone resorption by the use of membranes and last, Akhlaghi et al 10 who found that amniotic membrane loaded with buccal fat padderived MSCs improved the buccal bone significantly and his results were highly comparable to our results.…”

“…However, the blood supply of local flaps is mostly dependent on the pedicle of the flap, there is no well-known blood supply artery, and the size is limited. 6 Gomar-alba et al 7 used local flaps to repair huge dorsal meningocele flaps with small size limitation, but it would lead to lack of subcutaneous soft tissue. Choi et al 8 reported a 72-year-old patient who underwent resection of a huge thoracic spinal cord with a skin defect of 12×12 cm but without kyphosis.…”

“…The first category is local flaps, and most of the treatment methods for repairing skin defects are the use of local flaps. However, the blood supply of local flaps is mostly dependent on the pedicle of the flap, there is no well-known blood supply artery, and the size is limited 6 . Gomar-alba et al 7 used local flaps to repair huge dorsal meningocele flaps with small size limitation, but it would lead to lack of subcutaneous soft tissue.…”

A 20-Year Experience with Tissue Expansion for Large Cervical Fascial Defects: An Algorithm Based on Different Clinical Flap Designs

“…Previous studies have demonstrated that forehead flaps and deltopectoral flaps combined with tissue expansion technology provide more reconstruction materials that match the facial skin regarding color, texture, and thickness. [22][23][24][25] However, a hair-bearing flap does not meet the principles of plastic and reconstructive surgery. 2 The patients need further treatment, such as a laser hair removal technique, to improve the final outcome when using the expanded forehead flap to repair the sizable facial defect.…”

Repair of Scars and Tissue Deficiency With Free Grafts of Full-thickness Scalp in Secondary Unilateral Cleft Lip Deformity

“…As reported, the scalp has been widely used as split-thickness skin grafts or pedicled skin flaps for severe burn scars, 23 face reconstruction, 24,25 and tissue defects 26 . Surgeons found that compared with other types of skin grafts, the scalp as a donor site possess the following merits, including imperceptible scarring, quick wound healing, hair availability, convenient postoperative care, and minimal contractures after transplantation 27,28 .…”