The Clinical Outcome Of Delayed Expansion Of A Random Flap For Repairing Large Skin Defects Of The Head,Face And Neck

Background:Common causes of large skin defects on the head,face and neck include congenital pigmented nevi,keloids and neurofibromas.Patients often have high demands for restoration here.Large skin defects of the head,face and neck are a difficult problem in clinical repair as they tend to cause deformation of the facial features when repaired.Dilated flaps are one of the most common methods used today.The flap is divided into random flap and axial flap according to the absence or presence of well-known blood vessels within the flap.In clinical practice,we have found that although axial flaps have stable blood flow and can be repaired over a larger area,axial flaps such as the thoracic triangle flap require braking of the patient’s head and neck when the flap is not disconnected after transfer,which causes a lot of inconvenience to the patient’s life.Some of the axial flaps are distant from the recipient area,resulting in some differences in colour and texture between the flap transfer and the surrounding normal skin tissue.The adjacent expanded random flap without axial vessels has a limited repair area and cannot repair large defects in the head,face and neck.We therefore considered the possibility of combining an expanded flap with a delayed procedure,thereby increasing the blood flow of the random flap,the viability of the flap after transfer and the resectable area of the expanded flap.This would increase the flexibility of flap selection and provide patients with new and more appropriate options for clinical procedures.Objective:The use of a delayed expansion random flap in the repair of large skin lesions of the head,face and neck is discussed to provide implications for the design of delayed expansion random flaps in clinical practice and the choice of surgical procedure for the repair of large skin lesions of the head,face and neck.Methods:Ten patients treated at the Department of Plastic Surgery,First Affiliated Hospital of Jilin University from May 2019 to March 2023 were included in this study.Four of the patients were male and six were female,with the oldest age being 44 years and the youngest age being 12 years,with a mean age of 24 years.The lesions included: 2neurofibromas,4 pigmented nevi and 4 keloids.A total of 23 dilators were applied in10 patients.Not all flaps designed were random flaps,but all patients included in the study had at least one delayed dilatation random flap excised for repair.The aspect ratio,area,survival rate and postoperative complications of the delayed dilated random flaps were described and recorded in a retrospective study.A questionnaire was administered to the patients to compare their preoperative and postoperative changes in psychological and social functioning and to investigate their overall satisfaction with the surgical decision,etc.And regular post-operative follow-ups were conducted to observe the treatment results.Results:In all 10 patients,the large defect was repaired with a delayed adjacent expanded random flap and the flap survived well,with a 100% survival rate.The patients’ subjective satisfaction was very high and they felt that the treatment process had less impact on their lives.The patients’ postoperative psychological and social functioning increased significantly compared to the preoperative period,with a statistically significant difference.Delayed expansion of the random flap with a length to width ratio of up to 2.5:1 was found with good flap survival and no surgical complications.The defects were all successfully repaired and the surgical repair outcome was good.Conclusions:(1)After surgical delay,the expanded random flap has better blood flow and a higher flap viability rate than the undelayed expanded flap.(2)When delayed expanded random flaps are used to repair large skin defects on the head,face and neck,the adjacent random flap is similar in colour and texture to the surrounding normal skin,and patients are more satisfied with the procedure and feel less affected by the treatment process.(3)After surgical delay of the expanded adjacent random flap,the flap area can be designed to increase and the flap aspect ratio can reach 2.5:1 with good flap survival,which has important implications for flap design.