Local flaps are up to today the best choice for the reconstruction of minor facial cutaneous defects, such as loss of substance deriving from excisions of small cutaneous lesions, because the skin transferred through such flaps presents the same characteristics of the removed skin. Local flaps can vary in form and dimension and be axial or random type vascularization. In this study the authors report their experience on the use of the subcutaneous pedicled island flap, a local cutaneous flap with random vascularization, which assures good nutrition of the skin and optimal healing within a few days. The subcutaneous pedicled island flap allows us to obtain homogeneous skin with an aspect and thickness similar to the removed skin with reduced scarring and minor local tension. Such flap is easy to execute, can be done under local anesthesia with simple planning and with a relatively short operation time. After ablation of the part of the affected skin the flap is outlined at a peripheral border of the loss of substance and is incised up to the subcutaneous tissue. The pedicle is atraumatically prepaired avoiding traction and torsion movements that could hinder the circulation to the flap and, consequently, be responsible for partial or total necrosis. Once the flap and pedicle are modeled, they are transported to cover the receiver site by simple placement alongside it. In cases of lesions with diameters less than 3 cm, mobilization of only one flap is recommended. Multiple flaps should be used when the loss of substance is larger because excessive pedicle length could generate a traction phenomenon both on the receptive tissue and on the pedicle itself with subsequent damage to flap vascularization and adhesion failure. Data from our case series of 19 patients show that together with a good final aesthetic and functional result the immediate complications were rare with necrosis of the peripheral borders of the flap occurring in only one case of a multiple flap. However, after three months this complication was corrected to the dimensions of the flap whose randomtype vascularization was not immediately sufficient to supply blood to the site without any new intervention and with complete healing of the loss of substance. Considering its easy adaptability, the island flap is indicated for every region of the face. In the cases we have described it was applied five times in the malar region, three in the nasalroot and frontal regions, four in the labial region, and two in the reconstruction of the inner canthus of the eye and lower eyelid. In these last cases it was possible to obtain perfect healing also from the functional point of view permitting good restoration of eyelid capacity. In conclusion the authors believe that the island flap with a subcutaneous pedicle represents an optimal alternative for the reconstruction of facial defects of small diameter, allowing good results to be obtained, lower morbidity, and optimal satisfaction on the part of the patients.

The subcutaneous pedicled island flap: An alternative in facial skin reconstruction

Savastano G.
Conceptualization
;
Cortese A.
Supervision
2002-01-01

Abstract

Local flaps are up to today the best choice for the reconstruction of minor facial cutaneous defects, such as loss of substance deriving from excisions of small cutaneous lesions, because the skin transferred through such flaps presents the same characteristics of the removed skin. Local flaps can vary in form and dimension and be axial or random type vascularization. In this study the authors report their experience on the use of the subcutaneous pedicled island flap, a local cutaneous flap with random vascularization, which assures good nutrition of the skin and optimal healing within a few days. The subcutaneous pedicled island flap allows us to obtain homogeneous skin with an aspect and thickness similar to the removed skin with reduced scarring and minor local tension. Such flap is easy to execute, can be done under local anesthesia with simple planning and with a relatively short operation time. After ablation of the part of the affected skin the flap is outlined at a peripheral border of the loss of substance and is incised up to the subcutaneous tissue. The pedicle is atraumatically prepaired avoiding traction and torsion movements that could hinder the circulation to the flap and, consequently, be responsible for partial or total necrosis. Once the flap and pedicle are modeled, they are transported to cover the receiver site by simple placement alongside it. In cases of lesions with diameters less than 3 cm, mobilization of only one flap is recommended. Multiple flaps should be used when the loss of substance is larger because excessive pedicle length could generate a traction phenomenon both on the receptive tissue and on the pedicle itself with subsequent damage to flap vascularization and adhesion failure. Data from our case series of 19 patients show that together with a good final aesthetic and functional result the immediate complications were rare with necrosis of the peripheral borders of the flap occurring in only one case of a multiple flap. However, after three months this complication was corrected to the dimensions of the flap whose randomtype vascularization was not immediately sufficient to supply blood to the site without any new intervention and with complete healing of the loss of substance. Considering its easy adaptability, the island flap is indicated for every region of the face. In the cases we have described it was applied five times in the malar region, three in the nasalroot and frontal regions, four in the labial region, and two in the reconstruction of the inner canthus of the eye and lower eyelid. In these last cases it was possible to obtain perfect healing also from the functional point of view permitting good restoration of eyelid capacity. In conclusion the authors believe that the island flap with a subcutaneous pedicle represents an optimal alternative for the reconstruction of facial defects of small diameter, allowing good results to be obtained, lower morbidity, and optimal satisfaction on the part of the patients.
2002
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11386/4883464
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