Clinical Application Of Prefabricated Induced Expanded Flap Carried By The Superficial Temporal Fascial Flap

Objective: To investigate the operative methods, skills of prefabricated induced expanded flaps which carriers are superficial temporal fascial flaps pedicled on the parietal branches of the superficial temporal vessels for reconstruction of facial defects. Methods: The operation can be subdivided into two stages. The superficial temporal vessels and its parietal branches can be detected and marked before operations. At the first-stage, a fascial flap based on the parietal branches of the superficial temporal vessels was raised, and the size of the fascial flap varies from 5cm×4cm to 8cm×7cm and the average size was 6.8cm×5.2cm. The pedicle of the fascial flap was wrapped by a piece of silicone sheet. The donor sites, including cervical, postauricular-mastoid and forehead regions, were dissected to form a soft tissue pocket for the expander. The fascial flap based on the parietal branches of the superficial temporal vessels was leaded into the soft tissue pocket through a subcutaneous tunnel which was previously made from the pedicle to the soft tissue pocket. The fascial flap was made flat and anchored beneath the donor flap. Then an expander with appropriate size was buried beneath the fascial flap. 2 to 3 weeks later, the flap began to be expanded. When fully expanded, the expander was removed at the second-stage operation. Based on the parietal branch of the superficial temporal vessels, the flap, which used the superficial temporal fascial flap as a carrier, was elevated and transferred to resurface the wound while the scar or the naevus on the face had been resected. The size of the flaps ranged from 8cm×4cm to 17cm×7cm and the average size was 11.89cm×6.39cm. The donor sites were sutured directly or covered with splitted-thickness free skin grafting. Results: 10 cases have been treated with the method mentioned above. 4 cervical flaps, 5 postauricular-mastoid flaps and 1 forehead flap were involved. All the flaps survived totally postoperatively except one flap with distal necrosis which was transferred from postauricular-mastoid region. All the donors were closed directly expect one postauriclar-mastoid flap which was covered with splitted-thickness free skin grafting. Flap delay procedures have been performed on 7 patients before flap's transfer. The expansion time ranged from 3 to 5 months and the average time is 4.05 months. Conclusion: Techniques of flap prefabrication can help plastic surgeon to overcome the limit of the inherent vasculature of human body. An axial flap can be fashioned at the region without axial vascular vessels, or a random flap can be transformed to an axial flap by this technique. Techniques of flap prefabrication is modified and refined pattern of the traditional skin flaps. Flap expansion can not only induce the neovascularization of prefabricated flaps, but also offer large and thin flaps simultaneously. Furthermore, tissue expansion can help to close the donor sites, and reduce the secondary deformities of the donors.