Applications Of The Preoperative Multidetector-Row CT Angiography And Three-Dimensional Reconstruction Technology And Propeller Flap Techniques In Forehead Flaps

Part1The preliminary experience using the multidetector-row CT angiography and three-dimensional reconstruction technology in the preoperative planning of facial reconstruction with forehead flapsObjective:To evaluate the significance of preoperative MDCT angiography and three-dimensional reconstruction technology in the preoperative planning of facial reconstruction with forehead flaps.Methods:Preoperative MDCT angiography scans were performed on5patients who underwent facial reconstruction with forehead flaps from November2010to December2013and served as the test group. Another15cases who underwent facial reconstruction with forehead flaps without the use of preoperative MDCTA were selected as the control group. The ultrasonic Doppler examination were applied in the two groups, the operative methods were determined by the results of Doppler examination and experience of the senior surgeon as plan A. In the test group, the operations were re-designed based on the MDCTA results as plan B. The rate of the operative method changing, operation time, necrotic area of the flap and other complications were compared between the two groups.Results:The preoperative design changed in60%of the patients in the test group based on the MDCTA results. There were no changing in operative method in the control group (P<0.05). The complication rate with respect to the blood supply of the flaps was26.7%in the control group and none in the test group (P<0.05). Flap necrosis occurred in6.7%of the patients in the control group and none in the test group (P<0.05). The median time of the surgery was145min (Quartile Range was32min) in the test group and170min (Quartile Range was25min) in the control group (P<0.05).Conclusions:Preoperative MDCT angiography is an effective and reliable method for assessing the vasculature of the forehead flap and then guiding the selection of an appropriate operative method for each patient. The preoperative design of the flap can be more reasonable. It helps to save the operation time and avoid some major complications such as necrosis of the flap. Part2Forehead propeller flaps for the reconstruction of mid-facial defectsObjective:The forehead flap is a good option for the reconstruction of facial defects with excellent matches in color and texture. Propeller flap constitutes one of the biggest advances in flap surgery that greatly improves the abilities of the reconstructive surgeon dealing with soft-tissue defect reconstruction. This article describes our preliminary experience on mid-facial defect reconstruction using the frontal propeller flap and depicts some technical tips simultaneously.Methods:Between2011and2013, eight patients with mid-facial defects were treated with the forehead propeller flaps. In the first-stage operation, a150-300ml tissue expander was buried underneath the frontalis muscle. When adequate inflation of the expander has been achieved after4-7months (5.4months in average), a frontal propeller flap based on the supraorbital (SOA) and/or supratrochlear artery (STrA) was raised and rotated180degrees to repair the facial defect. There were a large superior blade of the flap which was used to resurface the resultant defect in the face, and a small inferior blade which was used aiding closure of the donor site, avoidance of kinking and twisting of the pedicle of the flap, minimizing the undue tension exerting on the vascular pedicle.Results:Supratrochlear artery (STrA) based propeller flaps were applied in5cases, and supraorbital (SOA) based propeller flaps in3cases. The mean size of the defects and flaps were7.63cm x4.88cm and12.13cm x8.13cm respectively. Follow-up period ranged from3to36months. All the flaps survived after the surgery without any major complications. All the patients were satisfied with the final aesthetic results.Conclusion:The results indicate that the forehead propeller flap based on the SOA and/or STrA can be an alternative option for the reconstruction of mid-facial defects.