gms | German Medical Science

124. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

01. - 04.05.2007, München

Face and Neck Reconstruction Using “Super-thin Flaps”

Meeting Abstract

  • S. Ono - Department of Plastic and Reconstructive Surgery, Nippon Medical School Hospital, Tokyo, Japan
  • R. Ogawa - Department of Plastic and Reconstructive Surgery, Nippon Medical School Hospital, Tokyo, Japan
  • H.O. Rennekampff - Department of Plastic, Hand, and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karls University Tuebingen, Germany
  • H. Hyakusoku - Department of Plastic and Reconstructive Surgery, Nippon Medical School Hospital, Tokyo, Japan

Deutsche Gesellschaft für Chirurgie. 124. Kongress der Deutschen Gesellschaft für Chirurgie. München, 01.-04.05.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. Doc07dgch7674

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Veröffentlicht: 1. Oktober 2007

© 2007 Ono et al.
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Background: The authors have reconstructed face and neck scar contractures using “Super-thin flaps”. A discriminating feature of the flap is its extremely thin form. It is primarily thinned to the layer where the subdermal vascular network (subdermal plexus) can be seen through minimal fat layer. Most of our reconstructions have been extensive post-burn scar contracture cases, for which we need extremely large but thin flaps to reconstruct wide, contour-sensitive areas such as the face and neck. For this reason, our flaps have been used mainly on the back and chest, with the help of microvascular augmentation.

Methods: Before the operation, each flap is designed to match the shape of the recipient site, and a judgment is made on whether there is any requirement for microvascular augmentation. In the operation, the recipient site is debrided and the recipient vessels are identified. Next, the flap is elevated from the periphery. Then the perforators scheduled to be used for anastomosis are confirmed macroscopically. After the flap is completely elevated, the flap is thinned down with curved scissors to the layer in which the subdermal vascular network can be seen through the minimal fat layer. After the donor site is covered with a split-thickness skin graft or primary suture, the thinned flap is rotated and applied to the recipient site. The vessels are anastomosed under microscopy in the microvascular augmented cases.

Results and discussion: Over ten years of experience has made us confident that “Super-thin flaps” are the best option for reconstructing areas around the face and neck. Reconstruction with regular thin flaps, including “perforator flaps” or expanded flaps, is the usual choice. However, for the purpose of complete functional and aesthetic reconstruction, we have to employ flaps that are much larger and thinner than might be expected pre-operatively. “Perforator flaps” have size limitations, and expanded flaps are likely to shrink and re-contract in the long term. Of course, allografts require immunosuppression and are associated with a lot of ethical problems. Therefore, we have employed “Super-thin flaps”, especially extremely large ones with microvascular augmentations, to reconstruct these contour-sensitive areas. It was suggested that not only partial face but also total face reconstruction can be done using the whole area of the