Face Reconstruction Using Lateral Intercostal Artery Perforator-Based Adipofascial Free Flap

BackgroundThe aim of this study was to determine the efficacy of lateral intercostal artery perforator-based adipofascial free flaps for facial reconstruction in patients with facial soft tissue deficiency.

MethodsWe conducted a retrospective study of five consecutive patients diagnosed with facial soft tissue deficiency who underwent operations between July 2006 and November 2011. Flap design included the area containing the perforators. A linear incision was made along the rib, which had the main intercostal pedicle. First, we dissected below Scarpa's fascia as the dorsal limit of the flap. Then, the adipofascial flap was elevated from the medial to the lateral side, including the perforator that pierces the serratus anterior muscle after emerging from the lateral intercostal artery. After confirming the location of the perforator, pedicle dissection was performed dorsally.

ResultsDominant perforators were located on the sixth to eighth intercostal space, and more than four perforators were found in fresh-cadaver angiography. In the clinical case series, the seventh or eighth intercostal artery perforators were used for the free flaps. The mean diameter of the pedicle artery was 1.36 mm, and the mean pedicle length was 61.4 mm. There was one case of partial fat necrosis. No severe complications occurred.

ConclusionsThis is the first study of facial contour reconstruction using lateral intercostal artery perforator-based adipofascial free flaps. The use of this type of flap was effective and can be considered a good alternative for restoring facial symmetry in patients with severe facial soft tissue deficiency.

Keywords

Perforator flap - Free tissue flaps - Face

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (R11-2005-065).

This study was presented at the 70th Congress of the Korean Society of Plastic and Reconstructive Surgeons, on November 2012 in Seoul, Korea and was presented at the 3rd Research and Reconstructive Forum, on May 2013 in Daegu, Korea.

Publikationsverlauf

Eingereicht: 29. Juli 2013

Angenommen: 20. September 2013

Artikel online veröffentlicht:
02. Mai 2022

• REFERENCES

• 1 Hamdi M, Spano A, Van Landuyt K. et al. The lateral intercostal artery perforators: anatomical study and clinical application in breast surgery. Plast Reconstr Surg 2008; 121: 389-396
• 2 Hamdi M, Van Landuyt K, de Frene B. et al. The versatility of the inter-costal artery perforator (ICAP) flaps. J Plast Reconstr Aesthet Surg 2006; 59: 644-652
• 3 Esser JF. Biological or artery flaps of the face. Monaco: Institut Esser de Chirurgie Structive; 1931
• 4 Kerrigan CL, Daniel RK. The intercostal flap: an anatomical and hemodynamic approach. Ann Plast Surg 1979; 2: 411-421
• 5 Badran HA, El-Helaly MS, Safe I. The lateral intercostal neurovascular free flap. Plast Reconstr Surg 1984; 73: 17-26
• 6 Daniel RK, Kerrigan CL. Intercostal neurovascular island skin flap. In: Strauch B, Vasconez LO, Hall-Findlay EJ. Grabb's encyclopedia of flaps. 2nd ed. Philadelphia: Lippincott-Raven; 1998: 1632-1635
• 7 Ogawa R, Hyakusoku H, Murakami M. et al. An anatomical and clinical study of the dorsal intercostal cutaneous perforators, and application to free microvascular augmented subdermal vascular network (ma-SVN) flaps. Br J Plast Surg 2002; 55: 396-401
• 8 Kroll SS, Rosenfield L. Perforator-based flaps for low posterior midline defects. Plast Reconstr Surg 1988; 81: 561-566
• 9 Hamdi M, Van Landuyt K, Monstrey S. et al. Pedicled perforator flaps in breast reconstruction: a new concept. Br J Plast Surg 2004; 57: 531-539
• 10 Van Landuyt K, Hamdi M, Blondeel P. et al. Autologous breast augmentation by pedicled perforator flaps. Ann Plast Surg 2004; 53: 322-327
• 11 Bostwick 3rd J, Scheflan M, Nahai F. et al. The "reverse" latissimus dorsi muscle and musculocutaneous flap: anatomical and clinical considerations. Plast Reconstr Surg 1980; 65: 395-399
• 12 Hwang KT, Kim SW, Kim JT. et al. Use of lateral intercostal artery perforator free flaps for resurfacing lower extremities. Ann Plast Surg 2013; 71: 186-190
• 13 Marano SR, Fischer DW, Gaines C. et al. Anatomical study of the superficial temporal artery. Neurosurgery 1985; 16: 786-790
• 14 Holzle F, Hohlweg-Majert B, Kesting MR. et al. Reverse flow facial artery as recipient vessel for perforator flaps. Microsurgery 2009; 29: 437-442
• 15 Faltaous AA, Yetman RJ. The submental artery flap: an anatomic study. Plast Reconstr Surg 1996; 97: 56-60
• 16 Badran HA, Youssef MK, Shaker AA. Management of facial contour deformities with deepithelialized lateral intercostal free flap. Ann Plast Surg 1996; 37: 94-101
• 17 Myung Y, Lee YH, Chang H. Surgical correction of progressive hemifacial atrophy with onlay bone graft combined with soft tissue augmentation. J Craniofac Surg 2012; 23: 1841-1844
• 18 Avelar RL, Goelzer JG, Azambuja FG. et al. Use of autologous fat graft for correction of facial asymmetry stemming from Parry-Romberg syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: e20-e25
• 19 Harashina T, Nakajima T, Yoshimura Y. A free groin flap reconstruction in progressive facial hemiatrophy. Br J Plast Surg 1977; 30: 14-16
• 20 Wallace JG, Schneider WJ, Brown RG. et al. Reconstruction of hemifacial atrophy with a free flap of omentum. Br J Plast Surg 1979; 32: 15-18
• 21 Upton J, Albin RE, Mulliken JB. et al. The use of scapular and parascapular flaps for cheek reconstruction. Plast Reconstr Surg 1992; 90: 959-971
• 22 Coessens BC, Van Geertruyden JP. Simultaneous bilateral facial reconstruction of a Barraquer-Simons lipodystrophy with free TRAM flaps. Plast Reconstr Surg 1995; 95: 911-915
• 23 Koshy CE, Evans J. Facial contour reconstruction in localised lipodystrophy using free radial forearm adipofascial flaps. Br J Plast Surg 1998; 51: 499-502
• 24 Zhang Q, Qiao Q, Zhou G. et al. Anterolateral thigh adipofascial flap for correction of facial contour deformities and micromastia. J Reconstr Microsurg 2010; 26: 341-345
• 25 Koshima I, Inagawa K, Urushibara K. et al. Deep inferior epigastric perforator dermal-fat or adiposal flap for correction of craniofacial contour deformities. Plast Reconstr Surg 2000; 106: 10-15