Traumatic Hemi Facial Soft Tissue Amputation. Immediate Surgical Flap Reconstruction

摘要

Large soft tissue defects of the face present a challenging reconstructive problem to the surgeon. Optimal treatment of facial soft tissue injury includes definitive reconstruction of the main aesthetic units of the face. The author presents a case of immediate soft tissue flap reconstruction of the face following a car accident. The accident resulted in significant loss of the left soft facial structures with exposed facial bone i.e. hemi facial soft tissue amputation. Immediate soft tissue reconstruction was performed utilizing a rotation cervico pectoral flap to cover the lower half of the face and transposition of a temporoparietal scalp flap to cover the upper half. Surgical case and post operative aesthetic results are being presented in this case report. Presented as a Scientific Poster at the 2002 ASPS/PSEF/ASMS Annual Scientific Meeting in San Antonio, November 2-6 Introduction The principles of immediate reconstruction of facial soft tissue defects following tumor excision, trauma are well documented in the literature (1,2,3,4,5). Aesthetic facial reconstruction requires adequate understanding of the face regional anatomy and the dynamics of tissue movement and the ability to use innovatively the tissue adjacent to the defect to create a reconstruction that preserves the function of the area and the cosmetic facial units.The temporoparietal scalp flap is a useful source of tissue for correcting aesthetic units of the face (6,7,8,9,10,11,12). The quality of the tissue may be enhanced, and a successful color and texture match may be achieved. The donor scar is hidden under the hair-bearing area. The cervicopectoral flap has the same characteristics as facial tissue, consisting of thin, pliable tissue with a perfect color match (13). Cervicopectoral rotation flaps provide a straightforward, reliable, and efficient means to reconstruct complex defects of the face, lateral skull base, and neck, with the potential for excellent cosmetic results. The pedicle of the flap is quite reliable and enables a wide range of applicability Case / Surgical Procedure The patient is 34 male pedestrian, while walking and crossing the highway a high speed car hit him. He fell down on his left facial side and lost his consciousness. Immediately he was taken to the hospital and intubated in the emergency room. On examination, there was major soft tissue loss of the left facial structures extending from the left forehead and temporoparietal region. The left temporalis muscle was avulsed with exposed temporal bone. The outer third of the eyebrow was also avulsed. The zygomatic body was exposed with fracture of the arch. The avulsed soft tissue extends downwards into the cheek to include branches of the facial nerve, anterior part of the parotid gland. There were multiple sites of exposure of the mandible ramus and body (Fig-1).