Total cheek resurfacing with split ascending neck flap: a new approach.

Abstract

Burn scars and other forms of extensive cheek deformities are a tragedy for patients and pose a great challenge to surgeons due to limited availability of well-matching donor sites. The skin of distant regions and skin transplants contrasts with the facial skin. The most suitable site for tissue in cheek reconstruction is the neck, but this resource is limited. Cervical skin expansion is often complicated by tissue necrosis. A new approach (technique) for resurfacing the scarred cheek with a split cervical flap is presented in this paper. Sixteen patients with extensive (covering more than half the area) cheek deformities (10 unilateral and 6 bilateral) were operated upon; ages ranged from 6 to 32 years old. First, the split neck flap is transposed on the cheek/cheeks, restoring the lower half; after stabilization of transferred tissues, the cervical flap on the cheeks undergoes balloon extension. Second, the cheek reconstruction is finished with an expanded neck flap. Axial flap circulation prevented tissue necrosis after the first stage of reconstruction. The cervical flap on the cheek tolerated the expander well. In all cases, the cheeks were resurfaced in full with optimally matching sensate skin posing no serious post-operative complications. Cervical skin on the face preserved its natural properties without soft tissue excess and donor site morbidity; neck and cheeks preserved normal contours. Good cosmetic outcomes make this technique preferable for adults and children, and the technique is indicated as the first step for deformed cheek resurfacing for patients with uninjured neck.