Correlation between the local perforator advancement flap for mid-face defects and the three dimensional configuration of the skin ligament
10.3760/cma.j.cn114453-20211228-00485
- VernacularTitle:局部穿支蒂推进皮瓣修复面中部软组织缺损与面中部皮韧带三维构筑的相关性研究
- Author:
Xinyi LI
1
;
Ming ZHANG
;
Wei ZHANG
;
Jinglong NING
;
Fei ZHU
;
Banghe WANG
;
Qingchun XI
;
Xiaojing LI
Author Information
1. 安徽医科大学第一附属医院整形外科，合肥 230022
- Keywords:
Facial injuries;
Facial neoplasms;
Local perforator advancement flap;
Advancement flap;
Skin ligament;
Correlation study
- From:
Chinese Journal of Plastic Surgery
2022;38(9):1079-1086
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical effect of local perforator advancement flap in repairing mid-face soft tissue defects and its correlation between with the three dimensional configuration of the skin ligament.Methods:1) 12 fresh adult cadaver specimens (7 males, 5 females, aged 54-87 years) were selected. After dehydration and degreasing of the cadaver head with acetone, plasticized and sliced with a fully transparent ultra-thin layer of epoxy resin, using a Leica MZ8 stereo microscope and a Leica DFC295 digital camera to observe and analyze the prepared slices, and observe the differences in the three-dimensional structural characteristics of the cutaneous ligaments in different parts of the midface (cheek, nose, orbital eyelid) . (2) A retrospective analysis was made of the case data of midface soft tissue defects admitted to the Plastic Surgery Department of the First Affiliated Hospital of Anhui Medical University from January 2015 to October 2021. All patients were repaired with local perforator advancement flap. The Pearson bivariate correlation test was used to analyze the correlation among flap advancement distance, flap area, flap aspect ratio, and defect size. The Kruskal-Wallis test was used to analyze the differences of flap area and flap aspect ratio in different parts of the midface.Results:1) Anatomical studies have shown that the running direction of the facial skin ligaments is the same as that of the expressive muscles, and their three-dimensional structures at the upper eyelid and the nasal and facial corners of the upper nasal alar are different. The upper eyelid skin ligaments run along the eyelid, while the upper nasal The supracutaneous ligaments run down the alar of the nose. (2) The clinical study included 18 patients, 8 males and 10 females, aged (65.1±22.9) years. The flaps of 18 patients survived after operation, the flap area was (13.85±9.38) cm 2, and the advancing distance was (1.94±0.75) cm. Statistical analysis showed that there was a correlation between the flap advancement distance and the flap incision area ( r=-0.712, P=0.022) and the flap aspect ratio ( r=-0.580, P =0.012). There was no correlation with the defect area ( r=-0.227, P=0.365) ; the aspect ratios of the cheek, nose and orbital lid flaps were 2.06±0.42 , 2.50±1.18, 3.25±0.93, and the differences were statistically significant ( H= 6.59, P=0.037). Conclusions:The local perforator advancement flap is an ideal method for repairing midface soft tissue defects. The differences in the construction of the skin ligaments in different parts of the mid-face will affect the ease of advancement of the flaps and other characteristics in each part, which may be the reasons for affecting the aspect ratio of the flap design.
