Innovative Application and Clinical Evaluation of the Wang-Yang Flap in the Reconstruction of Depressed Tissue Deformities

Summary:

The Wang-Yang (W-Y) flap is a novel surgical technique for reconstructing depressed scars and congenital earlobe clefts in pediatric patients. This study evaluated its clinical efficacy and outcomes. Three pediatric patients underwent W-Y flap reconstruction: one with a posttraumatic depressed scar on the lower lip and two with congenital earlobe clefts, 4–14 years of age. All procedures were performed under general anesthesia. For the lower lip scar, a full-thickness incision with meticulous dissection was performed to release surrounding tissue and reconstruct the orbicularis oris muscle, followed by W-Y flap advancement to achieve tension-free closure. In earlobe cleft cases, a similar surgical approach was applied, ensuring optimal contour restoration and functional outcomes. Postoperative recovery was uneventful, with no complications such as infection, hematoma, or flap necrosis observed at the 1-week follow-up. At the latest follow-up, which exceeded six months in all patients, the majority demonstrated favorable healing, with well-integrated reconstructions, minimal scarring, and no significant pigmentation or deformity. Most patients reported high satisfaction with both functional and aesthetic results. The W-Y flap is an effective and reliable technique for the reconstruction of pediatric lip and earlobe defects. By ensuring robust vascularity and minimal donor-site morbidity, it offers superior aesthetic and functional outcomes with a low complication rate. These findings support its clinical utility as a valuable addition to pediatric reconstructive surgery.

Takeaways

Question: This study aimed to evaluate the effectiveness of the Wang-Yang (W-Y) flap for the reconstruction of depressed tissue deformities, specifically for posttraumatic lip scars and congenital earlobe clefts in pediatric patients.

Findings: This clinical evaluation of 6 pediatric patients demonstrated that the W-Y flap is an effective and reliable technique for repairing depressed scars and earlobe clefts, with no complications and excellent aesthetic and functional outcomes after 3 months.

Meaning: The W-Y flap offers an innovative, minimally invasive solution for reconstructing lip scars and earlobe clefts in children, ensuring fast recovery and high patient satisfaction.

DESIGN PRINCIPLES AND SURGICAL OVERVIEW OF THE WANG-YANG FLAP

The design of the Wang-Yang (W-Y) flap is illustrated in Figure 1. The W-shaped and Y-shaped components are positioned on either side of the defect, with points A and B located at the junction of the flat and depressed areas. Triangle ACB serves as a tongue-shaped flap that is inserted into incision FG. The area enclosed by figures ACBEFD represents the depressed region, where the overlying skin or mucosa must be excised while preserving the underlying adipose tissue. Segments AD and DF, as well as BE and EF, function as rotating flaps, whereas flap ACB acts as an advancing flap.

Fig. 1.

Design schematic of the W-Y flap. A, Outline of the W-Y flap design, showing the placement of the W and Y components on either side of the defect. B, Illustration of the W-Y flap following flap closure, demonstrating the final contour achieved after precise skin approximation.

Once the flaps are approximated, as shown in Figure 1, point C coincides with point G, and segments AD and DF overlap, as do BE and EF. The design principles of the W-Y flap are as follows: (1) AD = DF, (2) BE = EF, (3) the distance from point C to line AB is equal to the length of FG, and (4) angles ∠ADF and ∠BEF should not be excessively large or small, typically ranging from 45 to 75 degrees.

The surgical procedure consists of 3 main steps: first, the incision line is designed based on the depressed area. (See Video [online], which displays the surgical design, elevation, and approximation of the W-Y flap. The video illustrates the W-shaped incision design, mobilization of local tissue, and tension-free closure resulting in restoration of a smooth and continuous contour for the repair of depressed tissue deformities, such as congenital earlobe clefts and posttraumatic lip scars.) While adhering to the basic principles, the incision line should be flexibly adjusted according to the characteristics of the depressed region to achieve optimal repair results. Second, the skin or mucosa is incised along the designed line, excising the tissue over the depressed area, and the relevant flaps are mobilized in the adipose layer to repair any muscular or adipose deficiencies. The corresponding flaps are then approximated and sutured in place. Third, an assessment is made to ensure that angles ∠ADF and ∠BEF do not result in “dog-ear” deformities, which should be corrected promptly if present. Once the outcome is deemed satisfactory, the incision is secured with a tension-relieving dressing (excluding lip incisions).

Video 1. This video displays the incision lines.

Download video file ^{(1.5MB, mp4)}

Three clinical cases demonstrate the effective application of the W-Y flap in managing depressed tissue deformities. In case 1, the W-Y flap was used to repair a congenital earlobe cleft (Fig. 2), whereas in case 2, it was applied for the reconstruction of a posttraumatic depressed scar on the lower lip. (See figures, Supplemental digital Content 1, which displays case 3, which further highlights the use of the W-Y flap in another congenital earlobe cleft repair, https://links.lww.com/PRSGO/E221.) The figures illustrate preoperative conditions and postoperative follow-up. These clinical examples underscore the efficacy of the W-Y flap in achieving favorable outcomes, with smooth contour restoration and satisfactory aesthetic results in both lip scar and earlobe cleft repairs (additional images are available upon request).

Fig. 2.

Application of the W-Y flap for the repair of congenital earlobe cleft. A, Preoperative lateral view demonstrating the congenital earlobe cleft deformity. B, Postoperative lateral view at 18 months, demonstrating successful long-term healing, stable contour restoration, and satisfactory aesthetic results following reconstruction with the W-Y flap. Note the absence of recurrence, hypertrophic scarring, or other complications.

DISCUSSION

Pediatric populations, due to their vigorous activities, have a heightened susceptibility to traumatic injuries, frequently resulting in depressed scars from scar contraction or tissue loss.^1,2 Additionally, congenital anomalies such as congenital earlobe clefts further predispose children to aesthetic deformities that negatively impact facial symmetry.³ These visible irregularities significantly affect psychosocial interactions and psychological health during critical developmental stages in childhood.^4–6 Consequently, effective reconstructive techniques are crucial for restoring anatomical integrity, improving cosmetic outcomes, and enhancing pediatric patients’ overall psychological and social well-being.

Traditional approaches, including scar excision and local flap techniques, have long been the mainstay in addressing small deformities resulting from pediatric injuries or congenital anomalies. For depressed scars caused by trauma, methods such as scar revision or subcision have proven effective in improving contour irregularities, whereas congenital cleft earlobes have been successfully treated with direct suturing or refined local flaps, such as Z-plasty or L-plasty.^7–9 These established techniques are widely accepted for their reliability and straightforward application, frequently yielding satisfactory aesthetic and functional results.

Building on these established approaches, the W-Y flap presents an innovative option designed to complement existing techniques. By optimizing the use of local tissues, this flap provides a refined method for reconstructing tissue depressions, offering benefits such as reduced donor-site morbidity and tension-free closure. Its unique zigzag configuration helps distribute tension evenly, whereas the tongue-shaped cross-flap smooths contour irregularities, resulting in favorable aesthetic outcomes. As a supplementary technique, the W-Y flap serves as a valuable addition to the surgeon’s reconstructive repertoire, particularly in cases where traditional methods may not fully address complex tissue dynamics.

Currently, the W-Y flap has been successfully applied in the repair of lip depressed scars and earlobe clefts, and its application warrants further expansion and refinement. As such, the W-Y flap holds significant promise as an alternative reconstructive option in pediatric plastic surgery, providing enhanced aesthetic outcomes and minimizing complications while facilitating a more efficient recovery process.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.

Supplementary Material

gox-13-e6997-s002.pdf ^{(14.1MB, pdf)}