Reconstructing Large Facial Defects by Optimizing the Utilization of Expanded Flap.

Abstract

Objective: This study aimed to investigate the optimization of expanded flaps for the repair of large facial defects, while also providing insights and strategies for the prevention and management of complications.

Methods: A retrospective study was conducted with 5 patients who underwent repair of skin soft tissue defects of the head and face with expanded flap at First Affiliated Hospital of Kunming Medical University between October 2018 and May 2021. Patient data were collected, including age, diagnosis, lesion area, and photographs, together with details of the type, volume, placement, and depth of the expander, the duration of expansion, the type of flap used for repair, and follow-up results. All patients with large soft tissue defects of the head and face, resulting from the resection of benign lesions, underwent preoperative implantation of expanders. The defects were subsequently repaired by established flap design principles after the expanded flap was obtained through continuous water injection and expansion.

Results: All 5 patients underwent successful surgery with complete flap survival. In 1 case, a failure of forehead expander placement was addressed by utilizing a expanded flap derived from the remaining 2 expanders. In addition, a case of cheek expander infection was resolved through the removal of the infected expander and repair using a expanded flap from the neck expander. One patient did not return for treatment of postoperative incisional scar hyperplasia due to her predisposition to keloids. The remaining 4 patients were actively followed postoperatively and exhibited flaps that closely matched the surrounding skin in color and texture. All patients were satisfied with their postoperative results and appearance.

Conclusions: In cases of significant soft tissue defects following the resection of benign cephalofacial lesions, the utilization of expanding flap repair is a practical and effective approach. When employed optimally, this technique results in more satisfactory postoperative outcomes and a reduction in complications.