Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas.
Semin Plast Surg. 2008 Nov;22(4):294-305. doi: 10.1055/s-0028-1095888.
Significant defects of the cheek present a reconstructive challenge due to their extremely visible site, as well as limited local tissue supply. In addition, the cheek abuts several structures of expressive function, such as the eye, mouth, and local facial musculature. To achieve satisfactory functional and aesthetic results, reconstruction of such defects requires careful three-dimensional restoration of all missing components, adequate texture matching, as well as functional restoration. Aesthetic reconstruction of facial defects should adhere to the priority goals of first preserving function and second achieving cosmesis. According to the size of the defect, location on the cheek, relationship to adjacent structures, available donor tissue, and existing skin tension lines, a host of techniques is available for closure. As a well-established principle in facial reconstructive surgery, one should use local tissue whenever possible to provide the best tissue for color and contour restoration. However, thoughtful reliance upon the "reconstructive ladder," including direct closure, skin grafting, local flap creation, regional flap placement, and free-flap repair, will invariably guide the surgeon in an optimal approach to cheek reconstruction.
由于颊部位置显眼，且局部组织供应有限，因此存在明显缺陷会带来重建挑战。此外，颊部毗邻多种具有表情功能的结构，如眼睛、嘴巴和局部面部肌肉。为了获得满意的功能和美学效果，此类缺损的重建需要仔细三维重建所有缺失的成分，充分匹配纹理，并实现功能恢复。面部缺损的美学重建应遵循以下首要目标：首先是保存功能，其次是达到美容效果。根据缺损的大小、颊部的位置、与相邻结构的关系、可用的供区组织和现有的皮肤张力线，可以采用多种技术进行关闭。作为面部重建外科的一项成熟原则，应尽可能使用局部组织，以提供最佳的组织用于颜色和轮廓修复。然而，明智地依赖“重建阶梯”，包括直接闭合、皮片移植、局部皮瓣形成、区域皮瓣放置和游离皮瓣修复，将始终指导外科医生选择最佳的颊部重建方法。
