VERSATILITY AND REFINEMENTS OF V/Y PERFORATOR FLAPS FOR FACIAL RECONSTRUCTION
DOI:
https://doi.org/10.32782/2226-2008-2023-4-16Keywords:
facial reconstruction, facial blood supply, V/Y flap, perforator flapsAbstract
Background. Y perforator flaps for facial reconstruction have gained great popularity in the last years. The advantages compared to randomized local flaps are the marked increased arc of rotation and transfer length as well as less lymphatic congestion. The paper aims to show the field of application in facial reconstruction and has the purpose to serve as a continuing education. Methods. With 6 clinical case presentations the versatility and some refinements of V/Y perforator flaps for facial reconstruction are presented. The general principle of the operative procedure is explained in detail. Results. Beside the well-known treatment options for the different facial areas with different perforator containing layers a novel myocutaneous forehead flap is introduced for reconstruction of a supraorbital defect. Conclusion. During the last years, V/Y perforator flaps have become an important tool for functional and aesthetical sufficient facial reconstruction. And it has proven its right of existence in facial plastic surgery.
References
Chu EA, Byrne PJ. Local flaps I: bilobed, rhombic, and cervicofacial. Facial Plast Surg Clin North Am 2009; 17: 349–60.
Kruter L, Rohrer T. Advancement Flaps. Dermatol Surg. 2015 Oct; 41 Suppl 10: 239–46. DOI: 10.1097/DSS.0000000000000497.
Yenidunya MO, Demirseren ME, Ceran C. Bilobed flap reconstruction in infraorbital skin defects. Plast Reconstr Surg. 2007 Jan; 119(1): 145–150.
Feinendegen DL., Langer M; Gault D: A combined V/Y-advancement and turnover flap for simultaneous perialar and alar reconstruction. British Journal of Plastic and Reconstructive Surgery 53: 248–250, 2000.
Niranjan NS, Price RD, Govilkar P. Fascial feeder and perforatorbased V-Y advancement flaps in the reconstruction of lower limb defects. Br J Plast Surg. 2000; 53: 679–689.
Pepper JP, Baker SR. Local flaps: cheek and lip reconstruction. JAMA Facial Plast Surg. 2013 Sep-Oct; 15(5): 374–82.
Feinendegen DL, Langer MF, Roldán JC. Refinement of nasal reconstruction with a V/Y-alar-perforator flap. Plast Reconstr Surg – Global Open. 2017 Jan 30; 5(1): 1195.
Yildirim S, Taylan G, Aköz T. Freestyle perforator-based V-Y advancement flap for reconstruction of soft tissue defects at various anatomic regions. Ann Plast Surg. 2007; 58: 501–506.
Tae Ho Yoon, In Sik Yun, Dong Kyun Rha, Won Jai Lee. Reconstruction of Various Perinasal Defects Using Facial Artery Perforator-Based Nasolabial Island Flaps. Arch Plast Surg 2013; 40: 754–760.
Kardisag S, Ozcan A, Sumer O, Ugurlu K. Single-stage ala nasi reconstruction: lateral nasal artery perforator flap. J Craniofac Surg 2010; 21: 1887–9.
Ruiz-Moya A, Lagares-Borrego A, Infante-Cossio P. Propeller facial artery perforator flap as first reconstructive option for nasolabial and perinasal complex defects. J Plast Reconstr Aesthet Surg 2015; 68: 457–63.
Kannan RY, Mathur BS. Perforator flaps of the facial artery angiosome. J Plast Reconstr Aesthet Surg 2013; 66: 483–488.
Qassemyar Q, Havet E, Sinna R. Vascular basis of the facial artery perforator flap: analysis of 101 perforator territories. Plast Reconstr Surg 2012; 129: 421–9.
Madorsky S, Do A, Meltzer O. Superior Extended Nasal Myocutaneous Island Flap: An Alternative to Forehead Flap Reconstruction of the Nose Facial Plast Surg Aesthet Med. 2020 Jul/Aug; 22(4): 294–300.
D’Arpa S, Cordova A, Pirello R, Moschella F. Free style facial artery perforator flap for one stage reconstruction of the nasal ala. J Plast Reconstr Aesthet Surg 2009; 62: 36–42.
Demirseren ME, Afandiyev K, Ceran C. Reconstruction of the perioral and perinasal defects with facial artery perforator flaps. J Plast Reconstr Aesthet Surg 2009; 62: 1616–20.
Hofer SO, Posch NA, Smit X. The facial artery perforator flap for reconstruction of perioral defects. Plast Reconstr Surg 2005; 115: 996–1003.
Blasius E. Operation von Narben. In: Blasius E, ed. Beiträge zur praktischen Chirurgie nebst einem Bericht über die chirurgisch-augenärztliche Klinik der Königlichen Universität zu Halle. Berlin: Verlag von A. Förstner; 1848: 238.
Hauben DJ. Ernst Blasius's contributions to plastic surgery. Plast Reconstr Surg. 1984 Oct; 74(4): 561–70.
Niranjan NS. An anatomical study of the facial artery. Ann Plast Surg 1988; 21: 14–22.
Lohn JW, Penn JW, Norton J, Butler PE. The course and variation of the facial artery and vein: implications for facial transplantation and facial surgery. Ann Plast Surg 2011; 67: 184–8.
Lengelé B. Le visage, le masque et le temps. Histoire naturelle de l’architecture segmentaire de la face. Bull Mem Acad R Med Belg 2001; 156: 377–89.
Manchot C. The cutaneous arteries of the human body. New York: Springer Science Business Media; 1983. Cormack GC, Lamberty RGH. The arterial anatomy of skin flaps. Edinburgh:Churchill Livingstone; 1986.
Salmon M. Artères de la peau. Paris: Masson et Cie; 1936. 104–116.
Cormack GC, Lamberty RGH. The arterial anatomy of skin flaps. Edinburgh: Churchill Livingstone; 1986.
Houseman ND, Taylor GI, Pan WR. The angiosomes of the head and neck: anatomic study and clinical applications. Plast Reconstr Surg 2000; 105: 2287–313.
Pilsl U, Anderhuber F. The external nose: the nasal arteries and their course in relation to the nasolabial fold and groove. Plast Reconstr Surg 2016; 138: 830.
Pilsl U, Anderhuber Fneugebauer S. The facial artery-The main blood vessel for the anterior face? Dermatol Surg 2016; 42: 203–8.
Alfertshofer MG et al. The Layered Anatomy of the Nose: An Ultrasound-Based Investigation. Aesthet Surg J. 2022 Mar 15; 42(4): 349–357.
