The Clinical Application Of The Expanded Supraclavicular Axial Flap For Faciocervical Reconstruction

Objective: By comparative observation on the clinicalapplication of the the supra-clavicular axial expanded flap and free skingraft surgery techniques in the face and neck reconstruction. Respectively,after their immediate、long-term follow-up observation of indicators, aswell as patient satisfaction surveys. Eventually we put forward theapplication of the supra-clavicular axial expanded flap technique in thefacio-cervical reconstruction could be regarded as a practical andeffective, safe and reliable new method. Method: A total165Cases wereretrospectively analyzed in the Department Of Plastic Surgery, SichuanAcademy Of Medical Sciences&Sichuan Province People’s Hospitalfrom2011to2011. All of these Patients with soft tissue defect in the faceand neck were suffered from trauma, tumor resection or scar contractureafter burn.40patients whom met the inclusion criteria were selected anddivided into two groups.these two groups were respectively used theexpansion of the supra-clavicular axial flap technique and free skin graftsurgery techniques. Through our observation of their short-term andlong-term follow-up, as well as patient satisfaction survey. We couldsynthetically evaluate their postoperative effect.Main Steps: A total65Cases were retrospectively analyzed in the Department Of Plastic Surgery,Sichuan Academy Of Medical Sciences&Sichuan Province People’sHospital from2011to2011. All of these Patients with soft tissue defect in the face and neck were suffered from trauma, tumor resection or scarcontracture after burn.40patients whom met the inclusion criteria wererandomly selected and divided into two groups.these two groups wererespectively used the expansion of the supra-clavicular axial flaptechnique and free skin graft surgery techniques. Through our observationof their short-term and long-term follow-up, as well as patient satisfactionsurvey. We could synthetically evaluate their postoperative effect.1.Theexpansion of supra-clavicular axial flap group: In the first surgicalstage,the tissue expander was carefully inserted under the deep fascia ofthe supra-clavicular axial flap. During the second stage,after adequateexpansion lasting2to3months, the facio-cervical scars were excised andthe expanded flap was then dissected and transferred into into recipientsite to cover the skin defect.2.Free skin graft group: preoperative designface and neck excising scope of diseased tissue or scar and marked, afterremoving diseased tissue to deep portion of normal tissue and fullyrelease, calculated require skin graft area, designed with unilateral orbilateral groin skin, removed the depth to the deep fascia layer thentrimmed the free flap into full thickness skin graft, sutured which to thefaciocervical secondary wound. And Vaseline gauze pad afterpressurization packaged fixed. After inguinal subcutaneous fully released,the donor site could be suturing directly. Postoperative Inguinal regionshould be proper compression bandaged to preventhematoma.3.Postoperative effect evaluation：1,3,6months,1year wereregarded as the recent and forward curative effect observation time postoperatively, operation effect evaluation was accorded to the followingindicators:1) Appearance: The repaired skin texture, color, softness, etc.2)Degree of contracture: to observe the repair skin flap or skincontracture after transplantation;3) Postoperative immediate andlong-term complications;4) the patient’s individual satisfaction (includingthe length of treatment cycle; the satisfaction survey for patientsPostoperative of the skin color, thickness, elasticity, texture; postoperativeshort and long term complications). Results：the expansionsupra-clavicular axial flap series：Twenty patients’ ages ranging between7and49years，with an average age of28years, the maximum flap areawas15cm×20cm, the minimum flap area was12cm×9cm.Eventually，19flaps were survived completely,1flap (5%) occurreddistal partial flap necrosis，which cured after dealing with thedressing.The free skin group series: Twenty patients aged from4to62years, with the mean age of33years, the maximum defect size was30×25cm, the smallest was2×4cm. Among these patients,3cases of earskin grafts,2cases of medial upper arm skin grafts,15cases of inguinalskin grafts. At last,16cases were fully alive,3cases (15%) occurred asmall area of necrosis, cured after dressing.1case (5%) took place skinpiece partial necrosis, accepted skin grafts again and then recovered.Through an average of12months follow-up, the color and texture ofsupraclavicular artery expanded flap with the faciocervical regionmatched well, no obvious shrinkage phenomenon of skin flap wasobserved. Expansion of supraclavicular flap contracture was significantly less than that of free skin flap group, long-term follow-up of patientssatisfaction was higher than that of free skin grafts group.Conclusion:Application of supra-clavicular axial expanded flap technique,postoperative skin color, texture, feeling all match the repaired area well.With excellent functional and aesthetic results. Which be applied toreconstruction is a practical and effective, safe and reliable method.