Resurfacing of Face and Neck Using Superthin Thoracodorsal Artery Perforator Free Flaps.

BACKGROUND: Resurfacing of facial and neck defects is challenging due to the unique skin color, texture, and thickness of the region. With the development of microsurgical reconstruction, perforator- free flaps can provide adequate soft tissue. However, despite various modifications, such flaps hardly satisfy cosmetic requirements, due to differences in color and bulkiness. We have used superthin thoracodorsal artery perforator (TDAp) free flaps to overcome these limitations. METHODS: Between January 2012 and January 2020, 15 patients underwent reconstructive procedures for facial and neck soft tissue defects using superthin TDAp free flaps. First a perforator was found above the deep fascia and a flap was elevated over the superficial fascia layer. A process named "pushing with pressure and cutting" was carried out before pedicle ligation until all the superficial fat tissue had been removed except for around the perforator. Patient satisfaction was evaluated using a questionnaire about color, contour, and overall satisfaction a minimum of 12 months after surgery. RESULTS: Flap size ranged from 6 × 4 cm to 25 × 14 cm (mean, 126.3 cm2). Final flap thickness ranged from 4 to 6 mm. (mean, 4.97 mm). All flaps survived without any loss and there were no flap-related complications. After a mean follow-up period of 14.4 months, patients were satisfied with the aesthetic results, and cervical range of motion increased by 11.25 degree on average in burn scar contracture patients. CONCLUSIONS: The superthin TDAp free flap is an excellent alternative to face and neck resurfacing, providing a large and thin flap with excellent color matching and good vascularity.

Reconstruction of midface defects using local flaps: An algorithm for appropriate flap choice.

BACKGROUND: Local flap surgery is commonly performed to cover defects with appropriate skin color and texture match. The purpose of this study was to present an algorithm for choosing an appropriate flap when reconstructing a midface defect using a local flap. METHODS: Between February 2013 and February 2019, 38 patients with midface defects underwent local flap surgery. All defects larger than 3 cm in diameter were reconstructed with perforator-based transposition flaps. Defects smaller than 3 cm in diameter were reconstructed differently depending on their location. Defects near the nasolabial fold (NLF) were reconstructed with perforator-based transposition flaps, whereas defects just on the NLF were reconstructed with VY advancement flaps. Defects distant from the NLF were also reconstructed with VY advancement flaps. RESULTS: Perforator-based transposition flaps were used in 22 cases and VY advancement flaps were used in 16 cases according to our new algorithm. All flaps survived without any complications. The aesthetic results were superior for VY advancement flaps, with higher patient satisfaction scores. The skin color match was similar for both flaps, but the contour was more natural in advancement flaps than in transposition flaps. However, transposition flaps had the benefits of being able to cover relatively large defects and allowing the donor scar to be hidden in a wrinkle line. CONCLUSION: The most suitable local flap for coverage of a midface defect can be chosen based on the patient's condition. By following our algorithm, appropriate reconstructions can be performed, with satisfactory results.