Dallas, Texas From the University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2012 Jun;129(6):1291-1299. doi: 10.1097/PRS.0b013e31824ecac7.
The cheek is a vast, well-vascularized facial subunit defined by the preauricular crease laterally, the mandible inferiorly, the lips and nasolabial fold medially, and the orbit-cheek crease and zygomatic arch superiorly. Reconstruction of the cheek commonly takes advantage of skin laxity in older patients and the relaxed skin tension lines of the face. Poor reconstructive techniques can cause or exacerbate significant deformities, especially in the oral and ocular regions.
Four hundred twenty-two cases of post-Mohs' cheek reconstruction were reviewed retrospectively. All cases were performed sequentially over 10 years by the senior author (J.F.T.). Indications, techniques, postoperative care, complications, and patient characteristics (e.g., age, sex, medical history, defect size, and skin quality) were taken into consideration for each case.
The procedures used for cheek reconstruction included direct closure (53 percent), cervicofacial advancement flaps (19 percent), perialar crescentic advancement flaps (8 percent), full-thickness skin grafting (8 percent), V-Y advancement flaps (2 percent), and free flaps (1 percent). Although no attempt was made to modify patients' anticoagulation status before surgery, no hematomas were reported. Nine patients had multiple procedures for cancer recurrence or new defects, and all but four operations were performed at a university hospital outpatient surgery center. Seventeen total complications were noted from distal flap necrosis (n = 2), ectropion (n = 7), wound healing (n = 7), and compromised vascular supply (n = 1).
Knowledge of aesthetic considerations and appropriate use of operative techniques yield optimum cheek reconstruction defined by successful wound closure, thoughtful scar placement, and minimal postoperative complications.
面颊是一个广阔的、血管丰富的面部亚单位，由耳前皱折向外侧、下颌向下方、唇和鼻唇沟向内侧、眶颊皱折和颧骨弓向上方界定。重建面颊通常利用老年患者的皮肤松弛和面部松弛的皮肤张力线。不良的重建技术会导致或加重明显的畸形，尤其是在口腔和眼部区域。
回顾性分析了 422 例 Mohs 术后面颊重建病例。所有病例均由资深作者（J.F.T.）在 10 年内连续进行。考虑了每个病例的适应证、技术、术后护理、并发症和患者特征（如年龄、性别、病史、缺损大小和皮肤质量）。
用于面颊重建的手术包括直接缝合（53%）、颈侧推进皮瓣（19%）、全层皮片移植（8%）、鼻翼旁新月形推进皮瓣（8%）、V-Y 推进皮瓣（2%）和游离皮瓣（1%）。尽管术前没有尝试改变患者的抗凝状态，但没有报告血肿。9 例患者因癌症复发或新的缺损而接受了多次手术，除 4 例外，所有手术均在大学医院门诊手术中心进行。有 17 例总并发症，包括远端皮瓣坏死（n=2）、外翻（n=7）、伤口愈合不良（n=7）和血管供应受损（n=1）。
了解美学考虑因素并适当运用手术技术，可以实现最佳的面颊重建，包括成功的伤口闭合、深思熟虑的瘢痕位置和最小化的术后并发症。
