In the Journals

Prefabricated flap, tissue expansion created monoblock flap for full facial resurfacing

Researchers in China used a combination of subcutaneously expanded skin and bone marrow mononuclear stem cell transplantation to create larger skin flaps to repair full facial skin defects in a recent study.

Total facial reconstructions were performed on five patients (aged 17 to 48 years), whose defects were caused by flame (n=3) or sulfuric acid burns (n=2). The researchers combined prefabricated flaps, skin overexpansion and bone marrow mononuclear stem cell (BM-MNC) transplantation to create a full facial monoblock flap that avoided multiple flaps and skin grafts.

Four patients received prefabrication of the cervicothoracic area and the fifth patient had an expanded superficial cervical artery flap performed. Expanders ranged from 400 mL to 600 mL and were implanted under the anterior chest skin. Three patients changed expanders because of deformity and required BM-MNC injections to prevent skin from becoming overly thin during expansion. One week after insertion, tissue expansion began, and the expander was inflated semiweekly with saline.

Final inflation volume ranged from 2,670 mL to 3,200 mL, and flaps ranged from 28 x 26 cm2 to 32 x 30 cm2. There were no arterial insufficiencies. Three patients required donor sites covered by split-thickness skin grafts, and one patient experienced flap infection that resulted in scarring of the lower lip and chin.

“After several revisions, good aesthetic and functional results were achieved,” the researchers said. “Extensive face skin and soft-tissue defects or deformities remain the most challenging dilemma for the reconstructive surgeon. The substitute for the face should have matched color and texture to the face, large size to cover massive defects and thinner thickness to mediate facial expression and coincide with the facial contour.”

Disclosure: The researchers report no relevant financial disclosures.