Zhang Shuo, Zhao Shuhan, Song Peijun, Xu Jing
Department of plastic surgery, First Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, Anhui Province 233000, China.
J Craniofac Surg. 2023;34(5):1532-1535. doi: 10.1097/SCS.0000000000009230. Epub 2023 Mar 13.
The transverse facial artery is an important source of zygomaticofacial blood, but its perforator flap is rarely reported. The aim of this study was to investigate the utility of a modified perforator flap based on facial aesthetic units and previous anatomic studies of transverse facial arteries.
All 18 elderly patients with zygomatic facial tumors underwent Mohs surgery. The V-Y and propeller flaps were designed according to the aesthetic unit of the defect site. Only a small portion of the fascia and fat surrounding the blood vessel are left, the rest of the flap is pruned to a thickness closer to the surrounding tissues. The surgical effect was comprehensively evaluated by an expert group. To assess the patient's postoperative quality of life, we administered the FACT-H & N (v 4.0) scale before and after surgery.
Among the 18 flaps, 10 were V-Y flaps and 8 were propeller flaps. The flaps of 18 patients survived, with adequate cheek, facial symmetry, and proper mouth opening. The flaps worked well and looked good at both the recipient and donor sites. According to the scale survey, the postoperative patients had a higher quality of life in terms of physiology, psychology, function, and other areas than the preoperative patients ( P <0.05).
A modified flap of the transverse facial artery can rotate flexibly and repair a larger area, as the blood flow is relatively constant near the zygomatic arch. It has a high clinical value in the treatment of zygomaticofacial tumors.
面横动脉是颧面部血供的重要来源，但其穿支皮瓣报道较少。本研究旨在基于面部美学单位及既往对面横动脉的解剖学研究，探讨改良穿支皮瓣的应用价值。
18例老年颧面部肿瘤患者均接受了莫氏手术。根据缺损部位的美学单位设计V-Y皮瓣和推进皮瓣。仅保留血管周围一小部分筋膜和脂肪，将皮瓣其余部分修剪至更接近周围组织的厚度。由专家组对手术效果进行综合评估。为评估患者术后生活质量，我们在手术前后使用FACT-H&N（v4.0）量表进行测评。
18个皮瓣中，V-Y皮瓣10个，推进皮瓣8个。18例患者的皮瓣均存活，面颊丰满、面部对称、开口正常。皮瓣在受区和供区效果良好。根据量表调查，术后患者在生理、心理、功能等方面的生活质量高于术前患者（P<0.05）。
改良面横动脉皮瓣可灵活旋转，修复面积较大，因颧弓附近血流相对恒定，在颧面部肿瘤治疗中具有较高临床价值。
