Reconstruction of the zygomatic cheek defects using a flap based on the pretragal perforator of the superficial temporal artery.

Abstract

The aim of this study was to create a new flap based method for zygomatic cheek defect reconstruction using the pretragal perforator from the superficial temporal artery. Ten fresh cadavers were dissected after vascular injection to study pretragal perforator distribution, length, and diameter. Twelve clinical cases of zygomatic cheek defects were reconstructed using pretragal perforator flaps. According to the location of the perforator that was preoperatively probed using an ultrasound Doppler blood flow detector and the zygomatic cheek defect condition, size, and distance from the distal border to the tragus and the flabby surrounding skin, we designed a spindle-shaped longitudinal flap in the preauricular region based on the pretragus. The flap was raised superficially to the superficial musculoaponeurotic system from the caudal border incised primarily to the cephalic border to create the perforator flap. The flap was sutured to the defect and the donor site was closed. Cadaver dissection showed a quite constant perforator given off by the superficial temporal artery or its auricular branches with an appearance rate of 85% anterior to the tragus. The average perforator length was 18.3 mm (range, 11.2-24.2 mm). The average perforator diameter was 0.65 mm (range, 0.4-1.15 mm). A total of 12 clinical cases were available for 6-12 month postoperative follow-up. Favorable survival, primary closure, and esthetic results were achieved without any complications. Zygomatic cheek defect reconstruction using the above-mentioned flap can achieve satisfactory esthetic and functional results and boasts a simple design, convenient procedure, reliable blood supply, and concealed donor site incision.