Cervicofacial flap : revisted

Advantages of Cervicofial flaps :
Operative time is short.
It causes minimum deviations in relations to important structures around cheek.
reduce surgical risk in high risk patients like old age, diabetic patients, un-controlled hypertension
It can provide excellent skin colour and texture match.

1. CERVICOFACIAL FALP : REVISTED Dr Kundan Department of Surgical oncology Mahavir Cancer Sansthan

2. Study design – Prospective study No of patients – 12 Size of defect – 4x7 to 5x11 cm defect Aims of study - Effectiveiness of Cervicofacial flap in reconstruction of cheek defects, - To assess whether it gives cosmetically and functionally good result without causing much deviations and deformity - To study complications of Cervicofacial flaps and its safety and benefits in high risk and debilitated patients.

3. Large cutaneous defects of the cheek and external ear present a reconstructive challenge. While free tissue transfer has been increasingly used for such defects, many patients with these malignancies are poor candidates for lengthy reconstructive surgery. The use of a cervicofacial or cervicothoracic advancement flap in head and neck surgery was first described by Esser in 1918 and the technique has since evolved considerably

4. classification system of Cabrera and Zide Zone 1 is bounded by the inferior orbital margin superiorly, the nasolabial crease medially and the gingival sulcus inferiorly. The lateral border extends up the medial border of the sideburn and joins the lateral canthus along an imaginary line. Zone - 2 is bounded by the lateral border of the sideburn descending inferiorly to the angle of the mandible following it medially, then curving superomedially over the malar prominence, and finally extending superolaterally toward the lateral canthus . Zone 2 refers to preauricular defects . Zone - 3 is bordered laterally by the midpoint of the mandible, the lower lip medially, gingival sulcus superiorly, and extends out to its lateral border that overlaps with zone 2. Zone 3 refers to buccomandibular defects and defines an area in the lower cheek region.

5. classification system of Cabrera and Zide

6. Reconstruction of cheek lesions will vary according to the size and location of the defect . Small lesions less than 3 cm in diameter may be excised and closed primarily. Lesions larger than this dimension if closed primarily would cause distortion of the surrounding facial features impairing cosmesis and perhaps function. Cheek defects from 3 to 5 cm in diameter may be closed satisfactorily with local flaps from within the cheek unit. For cheek defects larger than 5 cm, however, one must generally consider using regional flaps.

7. Blood supply of subcutaneous Cervicofacial flap is random pattern. multiple perforators to the skin which arise from deep facial artery, transeverse facial artery, and superficial temporal artery supply to flap by forming vascular channels. Anteriorly based flap derives its blood supply from submental artery and perforators of facial artery Cervicofacial flap carries dissection below superficial musculoaponeurotic system in the face and deep to platysma in the neck. On occasion, a skin graft for the donor site may be used.

8. Advantages Operative time is short. It causes minimum deviations in relations to important structures around cheek. reduce surgical risk in high risk patients like old age, diabetic patients, un-controlled hypertension It can provide excellent skin colour and texture match.

9. Complication Flap dehisence Flap ischemia Flap edema Ectropion

10. References Mustarde JC. Repair and reconstruction in the orbital region. A practical guide. Consultant plastic surgeon, Royal infirmary, Glasgow. ES. Livingstone Ltd. Edinbirgh and London. 1969;174-5,184-5,189. International Journal of Research in Medical Sciences | November 2016 | Vol 4 | Issue 11 Page 4674 Kaplon I, Goldwyn RM. The Versatility of the laterally based Cervico facial flap for cheek repaires Plast Reconst Surg. 1978;61;390-3. Liu FY, Xu ZF. The Versatile applications of cervicofacial and Cervicothoracic rotation flaps in head and Neck surgery. World J Surg Oncol . 2011;9:135. Coock TA, Israel JM. Cervical rotation flap for midface resurfacing. Arch Otolaryngology head Neck surg. 1991;117:77-82. Bokhari WA, Wang SJ. Modified approach to the cervicofacial rotation flap in the head and neck reconstruction. The Open Otorhinolaryngology J. 2011;5:18-24. Tann ST, Mac Kinnan . Deep plane cervicofacial flap a useful versatile technique in head and neck surgery. Head and Neck. 2006;28:46-55. Becker FF, Langford FPJ. Deep plane Cervicofacial flap for reconstruction of large defects. Arch Otolaryngology Head and neck sur. 1996:122(9):997-9. Crow ML, Crow FJ. Resurfacing large cheek defects with rotation flaps from neck. Plast Reconstr Surg. 1976;2;196-200. Austen WG, Parrett BM. The subcutaneous Cervicofacial flap revisited. Ann Plast surg. 2009;62:149-53. Hakim SG, Jacobsen HC. Including the Platysma muscle in a Cervicofacial skin rotation flap to enhance blood supply for reconstruction of vast orbital and cheek defects, anatomic considerations and surgical techniques. Int J Oral Maxillofac Surg. 2009;38:1316-9. Mitz V, Peyronie M. The superficial musculo-aponeurotic system (SMAS) in the parotid and cheek area. Plast Reconstr Surg. 1976;58(1):80-8. Juri J, Juri C. Cheek reconstruction with advancement rotation flaps. Clin Plast Surg. 1981;2: 223-6. Juri J, Juri C. Advancement and rotation of a large Cervicofacial flap for cheek repairs. Plast Reconstr Surg. 1979;5:692-6. Stark RB, Kaplan JM. Rotation of flaps neck to cheek. Plast Reconstr Surg. 1972;3:230-3.