Reconstruction of midface defects using local flaps

Abstract

Background: Local flap surgery is commonly performed to cover defects with appropriate skin color and texture match. The purpose of this study was to present an algorithm for choosing an appropriate flap when reconstructing a midface defect using a local flap. Methods: Between February 2013 and February 2019, 38 patients with midface defects underwent local flap surgery. All defects larger than 3 cm in diameter were reconstructed with perforator-based transposition flaps. Defects smaller than 3 cm in diameter were reconstructed differently depending on their location. Defects near the nasolabial fold (NLF) were reconstructed with perforator-based transposition flaps, whereas defects just on the NLF were reconstructed with VY advancement flaps. Defects distant from the NLF were also reconstructed with VY advancement flaps. Results: Perforator-based transposition flaps were used in 22 cases and VY advancement flaps were used in 16 cases according to our new algorithm. All flaps survived without any complications. The aesthetic results were superior for VY advancement flaps, with higher patient satisfaction scores. The skin color match was similar for both flaps, but the contour was more natural in advancement flaps than in transposition flaps. However, transposition flaps had the benefits of being able to cover relatively large defects and allowing the donor scar to be hidden in a wrinkle line. Conclusion: The most suitable local flap for coverage of a midface defect can be chosen based on the patient's condition. By following our algorithm, appropriate reconstructions can be performed, with satisfactory results.

A Useful and Effective Option for the Repair of Facial Defects: Vy Advancement Flaps and Modifications

“…The V-Y advancement flap is traditionally considered appropriate for the repair of relatively small defects. [1] Although Chang et al [11] recommended V-Y advancement flaps for defects under 3 cm in the algorithm they created for the selection of local flap options in the repair of midfacial defects, we were able to successfully close defects up to 6-7 cm in size using this flap. However, the advanced age of our patients worked to our advantage.…”

Reconstruction of large facial defects using a combination of forehead flap and other procedures

“…Patient satisfaction questionnaire survey was assessed based on contour, color matching, and scar formation. Responses were assessed on a 5-point scale for each item (1= very dissatisfied, 2= dissatisfied, 3= fair; 4= satisfied, 5= very satisfied) [ 9 , 10 ]. Answers were provided by the patients themselves in 18 cases; however, in three cases, evaluation was performed based on the responses provided by their closest caregivers because of the inability of the patients to communicate.…”

A retrospective study of flap selection for through-and-through cheek defect reconstruction

“…A successful reconstruction not only restores the function, but also improves postoperative appearance. The key to a successful reconstruction is the appropriate choice of flap, which is mainly based on the surgeons' experience and preference and often corresponds to none systematic indication [8,10].…”