Including the platysma muscle in a cervicofacial skin rotation flap to enhance blood supply for reconstruction of large orbital and cheek defects: anatomical considerations and surgical technique

摘要

Since its first description by Mustarde, the cheek advancement-rotation flap has been widely used for reconstructing cheek defects after skin excision and orbital defects after orbital exenteration. The rotation-advancement cervicofacial flap in the subcutaneous plane is a randomly based flap and hence the need to mantain a wide pedicle, which reduces its morbility. Consequently the flap is often sutured under tension and thus it is not uncommonly associated with distal edge necrosis. This risk is increased in smokers and in patients who have undergone radiation therapy. The deep plane cervicofacial flap (DPCFF), which includes the superficial musculoaponeurotic system (SMAS) represents a significant modification of the original technique. This is a musculo-fascio-cutaneous flap with axial blood supply. An infero-anteriorly based flap derives its blood supply from the submental and perforating branches of the facial vessels, whereas a posteriorly based flap is supplied by perforating branches of the superficial temporal vessels.Here we report a case of reconstruction after orbital exenteration with an infero-anteriorly based DPCFF.