Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
Facial Plast Surg Aesthet Med. 2021 Dec;23(6):430-436. doi: 10.1089/fpsam.2020.0484. Epub 2021 Apr 20.
Midface reconstruction is challenging because the structures and deformities involved are complicated. In this study, we present a strategy for integrally reconstructing nasal and midface defects, including hair-bearing defects, using extended forehead-expanded flaps. From 2015 to 2018, a total of 22 patients with midface defects underwent reconstruction with extended forehead-expanded flaps. The far end of the expanded flap, which included scalp hair, was used to cover the upper lip defect (Type 1). In cases with large perioral defects (Type 2), we designed two separate supratrochlear artery flaps, one with a shorter pedicle for nasal reconstruction and the other with a longer pedicle for partial reconstruction. The pedicle of the longer flap was saved for upper lip recovery after pedicle interruption. Among the 22 patients (13 male and 9 female), 17 were caused by burns and 5 by trauma. Nineteen patients had Type 1 defects, and three had Type 2 defects. The average postoperative follow-up was 17.6 ± 4.3 months. Patient satisfaction was excellent in most patients. Our extended forehead flap strategy can achieve aesthetic recovery of nasal and perioral defects with a single expansion treatment. The expanded flap can be flexibly designed to fit diverse midface defects.
面中部重建具有挑战性，因为涉及的结构和畸形较为复杂。本研究提出了一种使用额部扩展皮瓣整体重建鼻及面中部缺损（包括有毛发区域的缺损）的策略。2015 年至 2018 年，共 22 例面中部缺损患者采用额部扩展皮瓣进行重建。扩展皮瓣的远侧端（包括头皮毛发）用于覆盖上唇缺损（1 型）。对于口周较大缺损（2 型），我们设计了两个单独的滑车上动脉皮瓣，其中一个蒂部较短用于鼻重建，另一个蒂部较长用于部分重建。较长皮瓣的蒂部在蒂部阻断后用于上唇恢复。22 例患者中（男 13 例，女 9 例），17 例为烧伤所致，5 例为创伤所致。19 例为 1 型缺损，3 例为 2 型缺损。平均术后随访 17.6±4.3 个月。大多数患者对治疗效果非常满意。我们的额部扩展皮瓣策略可通过单次扩展治疗实现鼻及口周缺损的美学修复。扩展皮瓣可灵活设计，适用于多种面中部缺损。
