Deep plane cervicofacial flap: a useful and versatile technique in head and neck surgery

Large oncosurgical defects of the cheek present a challenging reconstructive problem, especially when skin resections are combined with other procedures such as parotidectomy and/or neck dissection.

We present our experience with the deep plane cervicofacial flap (DPCFF) for reconstructing zone 1 (n=7), zone 2 (n=6), and zone 3 (n=5) cheek defects resulting from excision of primary cutaneous malignancies (n=13) and metastatic parotid (n=6) and/or neck (n=4) disease with skin involvement. The patients were between 65 and 88 years of age (mean, 76.7 years). The design of the flap was determined by the location of the defect and the need for simultaneous parotidectomy and/or neck dissection. Sixteen flaps were anteriorly based, whereas two were posteriorly based.

Twelve patients underwent simultaneous parotidectomy (n=11) and/or neck dissection (n=10) and/or facial reanimation procedures (n=6). The size of the cutaneous defects ranged from 4 x 4 to 10 x 10 (mean, 5.6 x 5.3) cm. Eight patients received postoperative adjuvant radiotherapy to the primary site and/or parotid bed and neck. Superficial marginal flap necrosis occurred in one of the three patients who received definitive radiotherapy before salvage surgery and repair with DPCFF. Other complications included one hematoma, one ectropion, and one retraction of the lower eyelid. Apart from mild facial contour deficiency in two patients, excellent functional and cosmetic outcome with good skin color and texture match were achieved in all patients.

The DPCFF is a versatile reconstructive technique in head and neck surgery. It provides a simple solution for a variety of cheek defects as an excellent alternative to regional or free tissue transfer. It can be used when simultaneous parotidectomy and/or neck dissection and/or facial reanimation procedures are required. This composite musculo-fascio-cutaneous unit is reliable with excellent vascularity, because it has an axial blood supply. Division of the facial suspensory ligaments during elevation of the flap in the sub-superficial musculo-aponeurotic system (SMAS) plane increases the mobility of this flap, which facilitates transfer.