Propeller facial artery perforator flap for repairing defect after resection of skin malignant tumor at upper lip_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YAO Yuanzhen ,  TANG Xiujun , WANG Dali , WEI Zairong , WANG Bo , DENG Chengliang , ZHANG Ziyang , JIN Wenhu

Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China;

Corresponding author：

TANG Xiujun, Email: xiujunsszx@163.com

Keywords：

Facial artery perforator flap; propeller flap; facial tumor; upper lip; wound repair

DOI：

10.7507/1002-1892.201709126

Video：

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ObjectiveTo explore the effectiveness of propeller facial artery perforator flap to repair the defect after resection of skin malignant tumor at upper lip.MethodsBetween July 2012 and January 2017, 17 cases with skin malignant tumor at upper lip underwent tumor resection and the remained defect was repaired with propeller facial artery perforator flap. Among the 17 patients, 3 were male and 14 were female, with an average age of 57 years (range, 35-82 years). There were 5 cases of squamous cell carcinoma and 12 cases of basal cell carcinoma. The disease duration ranged from 4 months to 11 years with an average of 20 months. The tumor size ranged from 1.4 cm×0.3 cm to 3.1 cm×1.4 cm. The extended resection of the tumor tissue was performed according to the characters of tumor. According to the location, size, and shape of the defect and the position of facial artery perforator explored with Doppler ultrasonography, the propeller facial artery perforator flap was designed to repair the defect and partial donor site. The flap size ranged from 5 cm×2 cm to 7 cm×3 cm. The length of the perforator pedicle was 0.5–1.0 cm with an average of 0.8 cm. The defect at donor site was directly closed.ResultsCyanosis occurred in 3 cases of the distal flap after operation, then healing after symptomatic treatment. The remaining flaps survived successfully and the wound healed by first intention. Primary healing was obtained in the donor site. All the patients were followed up 6-36 months with an average of 18 months. The shape of the patient’s upper lip was good and the scar on the donor site was unconspicuous. There was no lip deformity, ala nasi deflection, facial tension, entilation dysfunction, or recurrence of tumor during follow-up. At last follow-up, the results of self-evaluation were very satisfactory in 13 cases and satisfactory in 4 cases.ConclusionBased on multiple advantages of good blood supply, large rotation range, aesthetic outcome, and slight injury of the donor site, propeller facial artery perforator flap is not only an optimal choice for repairing upper lip defect after resection of skin malignant tumors, but also can achieve good functional and cosmetic effectiveness.

Citation： YAO Yuanzhen, TANG Xiujun, WANG Dali, WEI Zairong, WANG Bo, DENG Chengliang, ZHANG Ziyang, JIN Wenhu. Propeller facial artery perforator flap for repairing defect after resection of skin malignant tumor at upper lip. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(2): 210-214. doi: 10.7507/1002-1892.201709126 Copy

1.	Hofer SO, Posch NA, Smit X. The facial artery perforator flap for reconstruction of perioral defects. Plast Reconstr Surg, 2005, 115(4): 996-1005.
2.	许瑾, 武朱明, 余勇, 等. 鼻唇沟皮瓣在修复面中部皮肤肿瘤术后缺损中的应用. 中华医学美学美容杂志, 2015, 21(6): 328-330.
3.	黄冶飞, 王志强, 曹余亮, 等. 鼻唇沟皮下蒂岛状皮瓣修复鼻部皮肤缺损. 中华整形外科杂志, 2013, 29(6): 460.
4.	吕建刚, 吕梦葛. 鼻唇沟皮瓣在面部急诊外伤修复中的应用价值. 中国医疗美容, 2016, 6(1): 13-14.
5.	张彬. 面部皮肤癌手术缺损修复的常用局部皮瓣. 中华耳鼻咽喉头颈外科杂志, 2011, 46(5): 433-436.
6.	赵涛, 薛小文, 王雷, 等. 局部皮瓣在 191 例面部创面美容修复与功能重建中的应用. 临床皮肤科杂志, 2013, 42(9): 567-569.
7.	龙剑虹, 孙杨, 杨兴华, 等. 上唇缺损畸形手术治疗的探讨. 中华整形外科杂志, 2013, 29(6): 427-431.
8.	张驰, 唐修俊, 王达利, 等. 风筝皮瓣在眉弓部良性肿瘤切除术后创面美容亚单位的美学修复. 中华整形外科杂志, 2017, 33(1): 12-15.
9.	蒋丽媛, 蒋立钊, 肖厚安. 旋转皮瓣和改良菱形皮瓣修复面部缺损的效果比较. 安徽医学, 2017, 38(1): 51-53.
10.	Houseman ND, Taylor GI, Pan WR. The angiosomes of the head and neck: anatomic study and clinical applications. Plast Reconstr Surg, 2000, 105(7): 2287-2313.
11.	Camuzard O, Foissac R, Georgiou C, et al. Facial artery perforator flap for reconstruction of perinasal defects: An anatomical study and clinical application. J Craniomaxillofac Surg, 2015, 43(10): 2057-2065.
12.	Ng ZY, Fogg QA, Shoaib T. Where to find facial artery perforators: a reference point. J Plast Reconstr Aesthet Surg, 2010, 63(12): 2046-2051.
13.	Qassemyar Q, Havet E, Sinna R. Vascular basis of the facial artery perforator flap: analysis of 101 perforator territories. Plast Reconstr Surg, 2012, 129(2): 421-429.
14.	Koshima I, Nanba Y, Tsutsui T, et al. Perforator flaps in lower extremity reconstruction. Handchir Mikrochir Plast Chir, 2002, 34(4): 251-256.
15.	Koshima I, Nanba Y, Takahashi Y, et al. Future of supramicrosurgery as it relates to breast reconstruction: free paraumbilical perforator adiposal flap. Semin Plast Surg, 2002, 16(1): 93-100.
16.	Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg, 2009, 124(5): 1529-1544.
17.	D'Arpa S, Pirrello R, Toia F, et al. Reconstruction of nasal alar defects with freestyle facial artery perforator flaps. Facial Plast Surg, 2014, 30(3): 277-286.
18.	Kannan RY, Mathur BS. Perforator flaps of the facial artery angiosome. J Plast Reconstructr Aesthet Surg, 2013, 66(4): 483-488.
19.	Innocenti M, Menichini G, Baldrighi C, et al. Are there risk factors for complications of perforator-based propeller flaps for lower-extremity reconstruction? Clin Orthop Relat Res, 2014, 472(7): 2276-2286.
20.	Wong CH, Cui F, Tan BK, et al. Nonlinear finite element simulations to elucidate the determinants of perforator patency in propeller flaps. Ann Plast Surg, 2007, 59(6): 672-678.

1. Hofer SO, Posch NA, Smit X. The facial artery perforator flap for reconstruction of perioral defects. Plast Reconstr Surg, 2005, 115(4): 996-1005.
2. 许瑾, 武朱明, 余勇, 等. 鼻唇沟皮瓣在修复面中部皮肤肿瘤术后缺损中的应用. 中华医学美学美容杂志, 2015, 21(6): 328-330.
3. 黄冶飞, 王志强, 曹余亮, 等. 鼻唇沟皮下蒂岛状皮瓣修复鼻部皮肤缺损. 中华整形外科杂志, 2013, 29(6): 460.
4. 吕建刚, 吕梦葛. 鼻唇沟皮瓣在面部急诊外伤修复中的应用价值. 中国医疗美容, 2016, 6(1): 13-14.
5. 张彬. 面部皮肤癌手术缺损修复的常用局部皮瓣. 中华耳鼻咽喉头颈外科杂志, 2011, 46(5): 433-436.
6. 赵涛, 薛小文, 王雷, 等. 局部皮瓣在 191 例面部创面美容修复与功能重建中的应用. 临床皮肤科杂志, 2013, 42(9): 567-569.
7. 龙剑虹, 孙杨, 杨兴华, 等. 上唇缺损畸形手术治疗的探讨. 中华整形外科杂志, 2013, 29(6): 427-431.
8. 张驰, 唐修俊, 王达利, 等. 风筝皮瓣在眉弓部良性肿瘤切除术后创面美容亚单位的美学修复. 中华整形外科杂志, 2017, 33(1): 12-15.
9. 蒋丽媛, 蒋立钊, 肖厚安. 旋转皮瓣和改良菱形皮瓣修复面部缺损的效果比较. 安徽医学, 2017, 38(1): 51-53.
10. Houseman ND, Taylor GI, Pan WR. The angiosomes of the head and neck: anatomic study and clinical applications. Plast Reconstr Surg, 2000, 105(7): 2287-2313.
11. Camuzard O, Foissac R, Georgiou C, et al. Facial artery perforator flap for reconstruction of perinasal defects: An anatomical study and clinical application. J Craniomaxillofac Surg, 2015, 43(10): 2057-2065.
12. Ng ZY, Fogg QA, Shoaib T. Where to find facial artery perforators: a reference point. J Plast Reconstr Aesthet Surg, 2010, 63(12): 2046-2051.
13. Qassemyar Q, Havet E, Sinna R. Vascular basis of the facial artery perforator flap: analysis of 101 perforator territories. Plast Reconstr Surg, 2012, 129(2): 421-429.
14. Koshima I, Nanba Y, Tsutsui T, et al. Perforator flaps in lower extremity reconstruction. Handchir Mikrochir Plast Chir, 2002, 34(4): 251-256.
15. Koshima I, Nanba Y, Takahashi Y, et al. Future of supramicrosurgery as it relates to breast reconstruction: free paraumbilical perforator adiposal flap. Semin Plast Surg, 2002, 16(1): 93-100.
16. Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg, 2009, 124(5): 1529-1544.
17. D'Arpa S, Pirrello R, Toia F, et al. Reconstruction of nasal alar defects with freestyle facial artery perforator flaps. Facial Plast Surg, 2014, 30(3): 277-286.
18. Kannan RY, Mathur BS. Perforator flaps of the facial artery angiosome. J Plast Reconstructr Aesthet Surg, 2013, 66(4): 483-488.
19. Innocenti M, Menichini G, Baldrighi C, et al. Are there risk factors for complications of perforator-based propeller flaps for lower-extremity reconstruction? Clin Orthop Relat Res, 2014, 472(7): 2276-2286.
20. Wong CH, Cui F, Tan BK, et al. Nonlinear finite element simulations to elucidate the determinants of perforator patency in propeller flaps. Ann Plast Surg, 2007, 59(6): 672-678.

Chinese Journal of Reparative and Reconstructive Surgery

Propeller facial artery perforator flap for repairing defect after resection of skin malignant tumor at upper lip

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