CONCISE PURPOSE: Resection of head and neck malignancies commonly results in significant fasciocutaneous defects of single or multiple cosmetic subunits.1 Reconstruction can be challenging due to patient age, comorbidities, and previous irradiation.2 The ideal reconstructive approach delivers locally matched tissue, based on reliable vasculature of the external carotid system,3 and minimizes donor site and perioperative morbidity. The Facial Artery Cheek Subunit (FACS) and Extended Facial Artery Cheek Subunit (EFACS) flaps are facial artery perforator flaps based on the aesthetic subunit of the cheek. They were developed to permit a multifaceted reconstructive approach to parotid and other fasciocutaneous defects to simultaneously reconstruct multiple subunits with locally matched tissue and address facial nerve paresis in a single procedure. We describe our experience with the first 50 patients.
METHODS AND MATERIALS: A cadaveric study was undertaken to examine the feasibility of the use of the cheek aesthetic subunit, with extensions into the neck as necessary, to achieve simultaneous reconstruction of adjoining defects (periauricular, perinasal, and perioral) and management of ipsilateral facial nerve dysfunction. A system was developed that utilizes selective facial retaining ligament release, islanding of the skin flap, tunnelling to permit the use of fascial slings and resuspension with elevation of perioral and perinasal skin relative to the cheek aesthetic unit, to achieve effective, and rapid management of facial ptosis. Fifty patients whose tumour extirpation resulted in a facial or neck fasciocutaneous defect underwent FACS or EFACS flap reconstruction to dually restore cosmetic subunits and address facial nerve palsy.
EXPERIENCE AND SUMMARY OF RESULTS: FACS and EFACS flaps were applied in over 50 patients for defects up to 120 cm2. There were no cases of flap loss. Only 1 had tip necrosis. Reconstructive time was under 2 hours in all patients. Postoperative wound infection occurred in 2 patients. All wounds healed within 2 weeks of surgery, and adjuvant radiotherapy was not delayed in any patient. No revisional surgery was necessary with the exception of periorbital procedures such as gold weight insertion, brow lift, and tarsorrhaphy in some cases. The approach successfully addressed the lower facial stigmata of facial muscle weakness.
REASONABLE AND UNDERSTANDABLE CONCLUSIONS: The FACS and EFACS flaps are versatile techniques that can reconstruct head and neck oncology defects and facial nerve palsy in a single operation. They may be used to address cheek, neck, periauricular, perioral and perinasal reconstruction, as well as the sequalae of facial nerve palsy. They are especially useful in high-risk patients because of their low complication rate, cost-effectiveness, and reduction of donor site morbidity.
REFERENCES:
1. Gonzalez-Ulloa M. Restoration of the face covering by means of selected skin in regional aesthetic units. Br J Plast Surg. 1956;9:212–221.
2. Behan FC, Rozen WM, Wilson J, et al. The cervico-submental keystone island flap for locoregional head and neck reconstruction. J Plast Reconstr Aesthet Surg. 2012;66:23–28.
3. Imanishi N, Nakajima H, Kishi K, et al. Is the platysma flap musculocutaneous? Angiographic study of the platysma. Plast Reconstr Surg. 2005;115:1018–1024.