Application of perforator flaps in cosmetic repair after facial malignant tumor resection
Chen Xiaoming1, Chen Lei1, Dai Qiang2, Xu Qiliang2, Shi Wenjuan2, Yu Daojiang1
1Department of Plastic and Burn Surgery, the Second Affiliated Hospital of Chengdu Medical College, Chengdu 610000, China; 2Department of Plastic and Burn Surgery, the Liyang People's Hospital, Liyang 215000, China
Abstract：Objective This study aimed to investigate the clinical application of perforator flaps in cosmetic repair after facial malignant tumor resection.Methods The retrospective and descriptive method was conducted. From February 2016 to February 2021, we treated 50 patients (20 males and 30 females, aged from 38 years to 95 years) with facial malignant tumor defects in the Department of Plastic and Burn Surgery of the Second Affiliated Hospital of Chengdu Medical College and the Liyang People's Hospital. After tumor resection, the areas of the facial skin defects ranged from 1.5 cm×1.5 cm to 3.5 cm×7.5 cm. The wounds were repaired by using a variety of facial perforator flap methods, such as propulsion, rotation, and propeller, in accordance with the sizes, positions, and shapes of the facial defects after the resection of the malignant tumors. The flap resections ranged from 1.5 cm×1.0 cm to 12.0 cm×6.0 cm. The diameters of the pedicle perforating vessels ranged from 0.3 mm to 3.0 mm, and in two cases, the peduncular perforator was the vascular bundle. Flap survivability was observed in terms of time after operation, and treatment was adopted in accordance with the symptoms that appeared. Flap color, function, aesthetics, and recurrence were followed up, and the wound repair effect was evaluated.Results The operation of all 50 cases in this group was successfully conducted. After operation, the wounds of 49 cases healed in the first stage, and one case of skin flap suffered from postoperative congestion and bleeding but improved after 1 week through acupuncture and local massage, and delayed wound healing. All incisions in the donor area healed in the first stage. All patients were followed-up for 3-24 months after surgery. The texture, color, and sensation of the flap were consistent with those of the surrounding skin, and donor scarring was not obvious. All 50 patients were satisfied with the donor and recipient function and appearance of the flap after surgery.Conclusions The use of perforator flaps to repair facial defects after the resection of facial malignant tumors is a safe and reliable method that has important clinical significance for the cosmetic repair of wounds after the resection of malignant tumors.
Thiem D, Scharr K, Pabst AM, et al. Facial cutaneous squamous cell carcinoma - microscopic safety margins and their impact on developing local recurrences[J]. J Craniomaxillofac Surg, 2020, 48(1): 49-55. DOI:10.1016/j.jcms.2019.11.022.
[2]
Badash I, Shauly O, Lui CG, et al. Nonmelanoma facial skin cancer: a review of diagnostic strategies, surgical treatment, and reconstructive techniques[J]. Clin Med Insights Ear Nose Throat, 2019, 12: 1179550619865278. DOI:10.1177/1179550619865278.
Elmelegy N, Elghamry S, Shoukr T. Free style perforator flaps for aesthetic facial reconstruction[J]. World J Plast Surg, 2019, 8(2): 195-199. DOI:10.29252/wjps.8.2.195.
[5]
Rogers-Vizena CR, Lalonde DH, Menick FJ, et al. Surgical treatment and reconstruction of nonmelanoma facial skin cancers[J]. Plast Reconstr Surg, 2015, 135(5): 895e-908e. DOI:10.1097/PRS.0000000000001146.
[6]
Fang CL, Hsu CH, Tu CW. Malignant phyllodes tumor recurrence in the pleural cavity via the deep inferior epigastric perforator flap and internal mammary vessel bundle: a case report[J]. Ann Plast Surg, 2019, 82(6): 618-621. DOI:10.1097/SAP.0000000000001795.
[7]
Sheckter CC, Maan ZN, Chang J. Cognitive independence in plastic surgery training: the value of professional development[J]. Plast Reconstr Surg, 2019, 144(1): 153e-154e. DOI:10.1097/PRS.0000000000005762.
[8]
Olariu R, Moser HL, Lese I, et al. The effects of optimizing blood inflow in the pedicle on perforator flap survival: a pilot study in a rat model[J]. Arch Plast Surg, 2020, 47(3): 209-216. DOI:10.5999/aps.2019.00871.
[9]
Yang DP, Zhang P. Facial resurfacing with prefabricated induced expanded skin flap[J]. J Craniofac Surg, 2019, 30(4): 1131-1134. DOI:10.1097/SCS.0000000000005152.
Cao SK, Yu DJ, An L, et al. Application of freestyle perforator flap to repair pressure sores in the buttocks[J]. Chin J Anat Clin, 2020, 25(4): 365-370. DOI:10.3760/cma.j.cn101202-20200130-00023.
[11]
Lyu D, Zou Y, Jin Y, et al. Stepwise, Multi-incisional, and single-stage approach to reshape facial contour after large cutaneous lesion resection[J]. 2017, 28(6): 1498-1501.
[12]
Zhu S, Liu Y, Zang M, et al. Facial defect reconstruction using the true scarless pre-expanded forehead flap[J]. J Craniofac Surg, 2018, 29(5): 1154-1160. DOI:10.1097/SCS.0000000000004450.
[13]
Yu D, Cao S, Zhang S. The application of a jigsaw puzzle flap based on a freestyle perforator and an aesthetic unit for large facial defects[J]. J Craniofac Surg, 2019, 30(5): 1529-1532. DOI:10.1097/SCS.0000000000005350.
Li L, Ju JH, Zhou ZH, et al. The application of DSA technique combined with color Doppler ultrasound in the location of the perforating branch of the anterolateral thigh flap[J]. Chinese Journal of Clinical Anatomy, 2020, 38(3): 331-334. DOI:10.13418/j.issn.1001-165x.2020.03.017.
Yu DJ, Cao SK, Cai WC, et al. Clinical effect of using free-style perforator flap based on aesthetic units on facial reconstruction after tumor resection[J]. Chin J Plast Surg, 2019, 35(11): 1096-1101. DOI:10.3760/cma.j.issn.1009-4598.2019.11.008.
[16]
Kannan RY, Mathur BS. Perforator flaps of the facial artery angiosome[J]. J Plast Reconstr Aesthet Surg, 2013, 66(4): 483-488. DOI:10.1016/j.bjps.2012.11.027.
Liao XN, Ren SX. Efficacy of facial artery perforator flap repairing procedure in patients with moderate area loss after facial tumor surgery[J]. Chin J Med Aesth & Cosmet, 2020, 26(3): 213-215. DOI:10.3760/cma.j.issn.1671-0290.2020.03.012
[18]
Durgun M, Özakpınar HR, Selçuk CT, et al. Repair of full-thickness nasal alar defects using nasolabial perforator flaps[J]. Ann Plast Surg, 2015, 75(4): 414-417. DOI:10.1097/SAP.0000000000000398.
[19]
康深松, 张正文, 牛扶幼, 等. 颜面部跨美容单位病变的修复[J]. 中国医学工程, 2005, 13(4): 418-419. DOI:10.3969/j.issn.1672-2019.2005.04.029.Kang SS, Zhang ZW, Niu FY, et al. Aesthetic reconstruction of lesion invading adjacent multi-areaes based on subunit in face[J]. China Medical Engineering, 2005, 13(4): 418-419. DOI:10.3969/j.issn.1672-2019.2005.04.029.
[20]
Mayo JL, Canizares O, Torabi R, et al. Expanding the applications of the profunda artery perforator flap[J]. Plast Reconstr Surg, 2016, 137(2): 663-669. DOI:10.1097/01.prs.0000475776.22020.b6.
[21]
Dölen UC, Baltu Y, Aydin O. Subunit reconstruction of mid-facial defects with free style facial perforator flaps[J]. J Craniofac Surg, 2018, 29(6): 1574-1577. DOI:10.1097/SCS.0000000000004535.
[22]
Kimura N, Saitoh M, Okamura T, et al. Concept and anatomical basis of microdissected tailoring method for free flap transfer[J]. Plast Reconstr Surg, 2009, 123(1): 152-162. DOI:10.1097/PRS.0b013e3181934756.
Yang SF, Wang CM, Liu LC, et al. Clinical effects of expanded super-thin perforator flaps in the shoulder, neck, and chest in reconstruction of extensive burn scars in the face[J]. Chin J Burns, 2019, 35(9): 661-667. DOI:10.3760/cma.j.issn.1009-2587.2019.09.004.
[24]
Jenkins D, Madani M, Fadel E, et al. Pulmonary endarterectomy in the management of chronic thromboembolic pulmonary hypertension[J]. Eur Respir Rev, 2017, 26(143) DOI:10.1183/16000617.0111-2016.
[25]
Madani MM. Surgical treatment of chronic thromboembolic pulmonary hypertension: pulmonary thromboendarterectomy[J]. Methodist Debakey Cardiovasc J, 2016, 12(4): 213-218. DOI:10.14797/mdcj-12-4-213.
2021, Vol. 26 
