Service de Stomatologie et Chirurgie Maxillo-Faciale, Centre Hospitalier de Cannes, Cannes, France.
PUI, Centre Hospitalier Régional Universitaire de Tours, Tours, France.
Microsurgery. 2024 Sep;44(6):e31238. doi: 10.1002/micr.31238.
Facial artery perforator (FAP) flap is a versatile and reliable one-step facial reconstruction technique. However, its full potential remains underutilized due to a lack of clear guidelines and rigorous technique requirements. This study report the use of FAP flaps in our centre for the management of perioral and nasal oncologic defects, focusing on surgical technique performed and post-operative management.
We conducted a retrospective review of all patients who underwent reconstruction with a perioral or perinasal FAP flap only following tumor resection over a 4-year period (n = 29). Parameters measured included flap survival, complication rates, surgical technique performed, and the need for touch-up procedures. Patients were grouped based on age, defect size, and location and outcomes were compared across these groups.
The mean histological tumor defect area was 331 mm. During at least 6 months of follow-up, no local recurrence was observed. Twenty-seven (93.1%) flaps survived completely. Major postsurgical complications occurred in seven (23.8%) patients, including complete flap necrosis (1), partial flap necrosis (1), flap collapse (1), venous congestion (1), wound dehiscence (1), and local infection (2). A higher complication rate was associated with nose tip defects (80.0% vs. 12.5%, p = 0.007). Touch-up procedures were more frequently required for reconstructions involving the nasal sidewall and dorsum (53.8% vs. 13.3%, p = 0.04).
Based on our experience, the FAP flap is highly effective for the reconstruction of the upper lip, nasolabial fold, and certain oncologic nasal defects. However, specific defect locations, such as the nose tip, may be associated with higher complication rates, necessitating careful patient selection and surgical planning.
面动脉穿支（FAP）皮瓣是一种多功能且可靠的一步式面部重建技术。然而，由于缺乏明确的指南和严格的技术要求，其全部潜力尚未得到充分利用。本研究报告了我们中心在治疗口周和鼻恶性肿瘤缺损方面使用 FAP 皮瓣的情况，重点介绍了所执行的手术技术和术后管理。
我们对 4 年内仅通过肿瘤切除后接受口周或鼻周 FAP 皮瓣重建的所有患者进行了回顾性研究（n=29）。测量的参数包括皮瓣存活率、并发症发生率、所执行的手术技术以及需要进行修复手术的情况。根据年龄、缺损大小和位置对患者进行分组，并对这些组的结果进行比较。
平均组织学肿瘤缺损面积为 331mm。在至少 6 个月的随访期间，未观察到局部复发。27 例（93.1%）皮瓣完全存活。7 例（23.8%）患者发生主要术后并发症，包括完全皮瓣坏死（1 例）、部分皮瓣坏死（1 例）、皮瓣塌陷（1 例）、静脉淤血（1 例）、伤口裂开（1 例）和局部感染（2 例）。鼻尖缺损的并发症发生率更高（80.0%比 12.5%，p=0.007）。涉及鼻侧和鼻背的重建需要进行修复手术的频率更高（53.8%比 13.3%，p=0.04）。
根据我们的经验，FAP 皮瓣对于上唇、鼻唇沟和某些鼻部恶性肿瘤缺损的重建非常有效。然而，特定的缺损位置，如鼻尖，可能与更高的并发症发生率相关，需要仔细选择患者并进行手术规划。
