Pre-expanded Thoracodorsal Artery Perforator-Based Flaps for Repair of Severe Scarring in Cervicofacial Regions

 

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Abstract

Background Reconstruction of cervicofacial scarring continues to present challenges for surgical treatment. Here we present our clinical experience in repairing cervicofacial scarring using pre-expanded thoracodorsal artery perforator flaps.

Methods From January 2007 to December 2012, 15 patients were treated for severe cervicofacial scarring. In the first surgical stage, expanders were implanted subcutaneously in the zone nourished by thoracodorsal artery perforators. The expansion generally took 3 to 6 months. In the second surgical stage, the cervicofacial cicatricial contracture was released and the secondary defect was covered with local flaps. The remaining wound was covered by the free thoracodorsal artery perforator expanded flap, which was anastomosed to the facial vascular bundle. The donor site was closed directly in all the patients.

Results The postoperative follow-up time ranged from 1 to 5 years. The deformities were corrected, all flaps survived completely and none were bulky. The maximum length of the flaps was 32 cm (mean, 22.4 ± 4.2 cm), and the maximum width was 17 cm (mean, 14.4 ± 2.2 cm). All patients exhibited recovery of neck movement, and there was no recurrence of neck contracture.

Conclusion The pre-expanded thoracodorsal artery perforator flap is an ideal method for reconstruction of severe cervicofacial cicatricial contracture.

Ethical Approval

Not required.

• References

• 1 Bartlett SP, May Jr JW, Yaremchuk MJ. The latissimus dorsi muscle: a fresh cadaver study of the primary neurovascular pedicle. Plast Reconstr Surg 1981; 67 (5) 631-636
  CrossrefPubMedGoogle Scholar
• 2 Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg 1995; 96 (7) 1608-1614
  CrossrefPubMedGoogle Scholar
• 3 Tobin GR, Schusterman M, Peterson GH, Nichols G, Bland KI. The intramuscular neurovascular anatomy of the latissimus dorsi muscle: the basis for splitting the flap. Plast Reconstr Surg 1981; 67 (5) 637-641
  CrossrefPubMedGoogle Scholar
• 4 Danahey DG, Dayan SH, Benson AG, Ness JA. Importance of chin evaluation and treatment to optimizing neck rejuvenation surgery. Facial Plast Surg 2001; 17 (2) 91-97
  Article in Thieme ConnectPubMedGoogle Scholar
• 5 Zhang YX, Wang D, Follmar KE , et al. A treatment strategy for postburn neck reconstruction: emphasizing the functional and aesthetic importance of the cervicomental angle. Ann Plast Surg 2010; 65 (6) 528-534
  CrossrefPubMedGoogle Scholar
• 6 Motamed S, Jahadi R, Asadi M, Motamed H. Burn scar reconstruction of the neck with FTSG obtained from lower abdominal skin. Acta Med Iran 2011; 49 (5) 310-313
  PubMedGoogle Scholar
• 7 Pallua N, Demir E. Postburn head and neck reconstruction in children with the fasciocutaneous supraclavicular artery island flap. Ann Plast Surg 2008; 60 (3) 276-282
  CrossrefPubMedGoogle Scholar
• 8 Vinh VQ, Van Anh T, Ogawa R, Hyakusoku H. Anatomical and clinical studies of the supraclavicular flap: analysis of 103 flaps used to reconstruct neck scar contractures. Plast Reconstr Surg 2009; 123 (5) 1471-1480
  CrossrefPubMedGoogle Scholar
• 9 Xianjie M, Zheng Y, Ai Y , et al. Repair of faciocervical scars by expanded deltopectoral flap. Ann Plast Surg 2008; 61 (1) 56-60
  CrossrefPubMedGoogle Scholar
• 10 Ninkovic M, Moser-Rumer A, Ninkovic M, Spanio S, Rainer C, Gurunluoglu R. Anterior neck reconstruction with pre-expanded free groin and scapular flaps. Plast Reconstr Surg 2004; 113 (1) 61-68
  CrossrefPubMedGoogle Scholar
• 11 Angrigiani C, Grilli D, Karanas YL, Longaker MT, Sharma S. The dorsal scapular island flap: an alternative for head, neck, and chest reconstruction. Plast Reconstr Surg 2003; 111 (1) 67-78
  CrossrefPubMedGoogle Scholar
• 12 Motamed S, Davami B, Daghagheleh H. Trapezius musculocutaneous flap in severe shoulder and neck burn. Burns 2004; 30 (5) 476-480
  CrossrefPubMedGoogle Scholar
• 13 Hafezi F, Naghibzadeh B, Pegahmehr M, Boddouhi N, Nouhi A. Extended vertical trapezius fasciocutaneous flap (back flap) in face and neck burn scar reconstruction. Ann Plast Surg 2008; 61 (4) 441-446
  CrossrefPubMedGoogle Scholar
• 14 Ogawa R, Hyakusoku H, Iwakiri I, Akaishi S. Severe neck scar contracture reconstructed with a ninth dorsal intercostal perforator augmented “Super-Thin Flap”. Ann Plast Surg 2004; 52 (2) 216-219
  CrossrefPubMedGoogle Scholar
• 15 Tsai FC, Yang JY, Chuang SS, Chang SY, Huang WC. Combined method of free lateral leg perforator flap with cervicoplasty for reconstruction of anterior cervical scar contractures: a new flap. J Reconstr Microsurg 2002; 18 (3) 185-190
  Article in Thieme ConnectPubMedGoogle Scholar
• 16 Mun GH, Jeon BJ, Lim SY, Hyon WS, Bang SI, Oh KS. Reconstruction of postburn neck contractures using free thin thoracodorsal artery perforator flaps with cervicoplasty. Plast Reconstr Surg 2007; 120 (6) 1524-1532
  CrossrefPubMedGoogle Scholar
• 17 Shen G, Xie F, Wang H, Gu B, Li Q. Resurfacing of lower face scars with a pre-expanded flap from the neck. Ann Plast Surg 2011; 66 (2) 131-136
  CrossrefPubMedGoogle Scholar
• 18 Pallua N, Machens HG, Rennekampff O, Becker M, Berger A. The fasciocutaneous supraclavicular artery island flap for releasing postburn mentosternal contractures. Plast Reconstr Surg 1997; 99 (7) 1878-1884 , discussion 1885–1886
  CrossrefPubMedGoogle Scholar
• 19 Khouri RK, Ozbek MR, Hruza GJ, Young VL. Facial reconstruction with prefabricated induced expanded (PIE) supraclavicular skin flaps. Plast Reconstr Surg 1995; 95 (6) 1007-1015 , discussion 1016–1017
  CrossrefPubMedGoogle Scholar
• 20 Lazzeri D, Su W, Qian Y , et al. Prefabricated neck expanded skin flap with the superficial temporal vessels for facial resurfacing. J Reconstr Microsurg 2013; 29 (4) 255-262
  Article in Thieme ConnectPubMedGoogle Scholar
• 21 Ayhan S, Tuncer S, Demir Y, Kandal S. Thoracodorsal artery perforator flap: a versatile alternative for various soft tissue defects. J Reconstr Microsurg 2008; 24 (4) 285-293
  Article in Thieme ConnectPubMedGoogle Scholar
• 22 LoGiudice J, Gosain AK. Pediatric tissue expansion: indications and complications. J Craniofac Surg 2003; 14 (6) 866-872
  CrossrefPubMedGoogle Scholar
• 23 Hudson DA. Maximising the use of tissue expanded flaps. Br J Plast Surg 2003; 56 (8) 784-790
  CrossrefPubMedGoogle Scholar
• 24 Teot L, Cherenfant E, Otman S, Giovannini UM. Prefabricated vascularised supraclavicular flaps for face resurfacing after postburns scarring. Lancet 2000; 355 (9216) 1695-1696
  CrossrefPubMedGoogle Scholar