Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan, Beijing, China.
J Craniofac Surg. 2023 May 1;34(3):936-941. doi: 10.1097/SCS.0000000000009135. Epub 2022 Nov 24.
This study aimed to describe the application of transferring preexpanded forehead flaps based on the supratrochlear and supraorbital arteries in 3 patterns for facial reconstruction: Pattern I, interpolated flap; Pattern II, island flap; and Pattern III, propeller flap, which was subdivided into direct propeller flap (Pattern IIIa) and indirect propeller flap (Pattern IIIb). During the first stage, a tissue expander was inserted underneath the forehead. After sufficient inflation of the expander, a forehead flap based on the supratrochlear or supraorbital artery was elevated and transferred to reconstruct the facial defects. Three weeks after the surgery, pedicle division was performed, in which Pattern I and Pattern IIIb flaps were used. Twenty-four patients underwent facial reconstruction. Twenty-three flaps survived without any perfusion-related complications. Venous congestion developed in an island flap. All patients were followed up after surgery, ranging from 2 to 156 (mean, 19) months. The color and texture of the flap matched those of the adjacent skin. The patients and their families were satisfied with the final functional and esthetic outcomes. The forehead flap based on the supratrochlear and supraorbital arteries provides reliable coverage of facial defects. The conventional interpolated flap continues to be the most dependable. Single-stage reconstruction using the island flap and direct propeller flap is applicable to patients who decline the pedicle division procedure. The novel technique of using the indirect propeller flap is safe for cheek reconstruction with minimal donor-site morbidity and esthetically pleasing results.
模式 I，插入瓣；模式 II，岛瓣；模式 III，推进瓣，可进一步分为直接推进瓣（模式 IIIa）和间接推进瓣（模式 IIIb）。在第一阶段，将组织扩张器插入额部下方。在扩张器充分膨胀后，抬起基于滑车上动脉或眶上动脉的额瓣并转移以重建面部缺损。手术后 3 周进行蒂部切断，其中使用模式 I 和模式 IIIb 瓣。24 例患者接受了面部重建。23 个皮瓣存活，无任何与灌注相关的并发症。岛瓣出现静脉淤血。所有患者均在术后进行了随访，随访时间为 2 至 156 个月（平均 19 个月）。皮瓣的颜色和质地与邻近皮肤相匹配。患者及其家属对最终的功能和美容效果满意。基于滑车上动脉和眶上动脉的额瓣为面部缺损提供了可靠的覆盖。传统的插入瓣仍然是最可靠的。对于拒绝蒂部切断术的患者，使用岛瓣和直接推进瓣的单阶段重建是适用的。使用间接推进瓣的新技术用于颊部重建是安全的，供区并发症少，且美容效果令人满意。
