Longaker M T, Glat P M, Zide B M
Institute of Reconstructive Plastic Surgery, New York University Medical Center, USA.
Plast Reconstr Surg. 1997 Jan;99(1):16-21. doi: 10.1097/00006534-199701000-00003.
The temporal and cheek areas are particularly vulnerable to sun damage and therefore to skin cancers. Rotation-advancement flaps are used commonly in the reconstruction of these regions following resection of skin cancers. Such flaps usually are modifications of the Mustardé, cervicofacial, and Juri flaps. The drawbacks to these flaps relate to a random, unpredictable perfusion with skin loss at the distal flap tip, a vertically oriented dog-ear that predictably is located on the cheek, and the risk of gravitational and cicatricial forces acting on the lower eyelid causing ectropion. The deep-plane technique for raising cheek flaps, as has been described recently for use in rhytidectomy, allows the plastic surgeon to address both drawbacks of the standard cervicofacial flaps. The vertical "hike" deep-plane approach addresses both drawbacks of the rotation-advancement flaps by including better perfusion and superior mobility after release of restraining ligaments. We describe the anatomic rationale for the deep-plane dissection of the cheek in cadaver studies and present our clinical technique with a vertical "hike" cheek advancement with removal of the horizontally oriented dog-ear as in a blepharoplasty. This single-stage technique will be called the deep-plane "hike" flap. The vertically advanced flap must be slightly overcorrected by anchoring the flap to the periosteum just above the recipient defect. This deep fixation removes all tension from the skin and prevents ectropion. This single-stage reconstruction affords excellent cosmetic results without compromising any future reconstructive efforts.
颞部和颊部特别容易受到阳光损伤，因此也容易患皮肤癌。在皮肤癌切除术后，旋转推进皮瓣常用于这些区域的重建。此类皮瓣通常是Mustardé皮瓣、面颈部皮瓣和Juri皮瓣的改良型。这些皮瓣的缺点包括血供随机、不可预测，皮瓣远端易出现皮肤坏死；在脸颊上可预测地出现垂直方向的“狗耳”畸形；以及重力和瘢痕挛缩作用于下眼睑导致睑外翻的风险。最近描述的用于除皱术中的深层平面技术掀起颊部皮瓣，使整形外科医生能够解决标准面颈部皮瓣的这两个缺点。垂直“提升”深层平面入路通过在松解限制韧带后提供更好的血供和更高的活动度，解决了旋转推进皮瓣的两个缺点。我们在尸体研究中描述了颊部深层平面解剖的解剖学原理，并展示了我们的临床技术，即采用垂直“提升”颊部推进术，并像在眼睑成形术中一样去除水平方向的“狗耳”畸形。这种单阶段技术将被称为深层平面“提升”皮瓣。必须通过将皮瓣固定在受区缺损上方的骨膜上，对垂直推进的皮瓣进行轻微的过度矫正。这种深层固定消除了皮肤上的所有张力，防止睑外翻。这种单阶段重建可提供出色的美容效果，而不会影响未来的任何重建工作。
