Applied anatomy of lateral maxillocervical boot-shaped perforator fasciocutaneous flap and clinical outcome in reconstructing zygomatic-temporal soft tissue defect
10.3760/cma.j.cn114453-20210822-00357
- VernacularTitle:侧颌颈靴形穿支筋膜皮瓣的应用解剖及其修复颧颞部软组织缺损的效果
- Author:
Haoran CHENG
1
;
Xi LI
;
Yu LIU
;
Xinyi LI
;
Jinlong NING
;
Xiaojing LI
;
Maolin TANG
;
Wenjing WANG
;
Qingchun XI
Author Information
1. 安徽医科大学第一附属医院整形外科，合肥 230032
- Keywords:
Surgical flaps;
Perforator fasciocutaneous flap;
Anatomy;
Zygomatic-temporal defect;
Reconstructive surgical procedures
- From:
Chinese Journal of Plastic Surgery
2022;38(2):152-158
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the anatomy of lateral maxillocervical boot-shaped perforator fasciocutaneous flap and its clinical effect on repairing soft tissue defect of zygomatic-temporal region.Methods:(1)From December 2017 to December 2020, five fresh adult cadaver specimens were infused with gelatin lead oxidate and underwent one-time arteriography.The X-ray image was imported into Mimics 17.0 software, divided and colored based on the head and face anatomy, and the distribution and anastomosis of the arteries involved in the lateral maxillocervical boot-shaped perforator fasciocutaneous flap were observed.The head and neck samples of another 5 (10 sides) fresh adult cadavers were infused with red latex artery to establish the surgical model, and then dissected layer by layer to investigate the blood supply and the source of perforating artery of this flap.(2) The patients with zygomatic-temporal lesions were treated in the Department of Plastic Surgery, the First Affiliated Hospital of Anhui Medical University.They were treated with the lateral maxillocervical boot-shaped perforator fasciocutaneous flap to repair the wound left after lesion resection. The survival of the flap and the healing of the incision were observed after surgery and the appearance and sensation of donor and recipient sites as well as tumor recurrence were followed up.Results:(1) The pedicle of the lateral maxillocervical boot-shaped perforator fasciocutaneous flap is mainly nourished by the superficial temporal artery and its perforator.The average diameter of the maximum three perforations is (0.44±0.04) mm, (0.90±0.08) mm, (0.73±0.05) mm.The fascial vascular network and subdermal vascular network formed by perforating arteries from superficial temporal artery and branching arteries from facial artery at different layers are the anatomical basis for ensuring blood supply of lateral maxillocervical boot-shaped perforator fasciocutaneous flap. (2) A total of 12 patients with zygomatic-temporal lesions were treated clinically, including 8 males and 4 females aged 42-79 years, including 2 cases of senile sebaceous keratosis, 3 cases of squamous cell carcinoma, 1 case of skin ulcer and 6 cases of basal cell carcinoma. The range of defect after resection of the lesions was 4 cm×3 cm-9 cm×8 cm. The flap area was 5 cm×3 cm-11 cm×9 cm, the flap pedicle width was 2-3 cm, length was 2-4 cm, After surgery, the blood supply of the flap was good without necrosis, the wound were covered by first treatment. After 6-18 months of follow-up, the donor and recipient areas presented natural appearance, no swelling, no paresthesia and facial paralysis, and no recurrence of cancer.Conclusions:The lateral maxillocervical boot-shaped perforator fasciocutaneous flap pedicled with perforating branch of superficial temporal artery has reliable blood supply. Using this flap to repair large soft tissue defects in zygomatic-temporal region has the advantages of simple operation, similar color and texture, and good appearance.
