Reconstructive Algorithm Of Soft-tissue Defect In Zone1 Of The Cheek

Objective:This study is dedicated to reviewing and analysis of the reconstructive choices available for zone1of cheek defect reconstruction. According to our own experience, we put forward the reconstructive principles for soft-tissue defect reconstruction in zone1of the cheek, providing the therapeutic guidance for choice of suitable reconstructive approach.Methods:63cases were included in this study, with31males and32females. The age of patients ranged from3to69years old, with an average of21.5years old. All of the patients included in this study suffered tissue defects in the cheek region, among them,16cases underwent surgical reconstruction with skin grafts,9cases with expanded cervicofacial flaps,7cases with non-expanded forehead island flaps,10cases with expanded forehead island flaps,6cases with medial arm flaps,5cases with prefabricated flaps, and10cases with free flaps. The survival rate of the flaps or skin grafts, additional surgery ratio and the satisfaction of the patients were assessed after the surgery.Results:The size of the defects ranged form1.5cm×1.0cm to15.0cm×8.0cm. Skin grafts took completely in all cases, but12.5%of them underwent complementary surgery. In patients who received flap transfer, the rate of flap survival and the additional surgery were88.9%and55.6%for cervicofacial flap transfer,100%and14.3%for non-expanded forehead flap transfer,100%and70%for expanded forehead flap transfer,100%and83.3%for medial arm flap transfer,80%and60%for prefabricated flap transfer, and100%and40%for free flap transfer.Conclusions:The cervicofacial flap is the first choice for small-sized defect reconstruction in zone1of the cheek with non-expanded forehead flap transfer comes as secondary. The expanded forehead flap is the best choice for medium to large-sized defects. When defects are too large in size to be resurfaced with local flaps, the expanded medial arm flap should be taken into consideration owing to its similar color with the recipient site and ample post-operative contour. When the local and regional flaps are unavailable or cannot provide the tissue volume required, the free flap should be considered. Defects resulted from acute trauma and tumor ablation can be covered temporarily by skin grafts, and then resurfaced with flaps transfer in the second stage.