An algorithm for total and subtotal facial reconstruction using an expanded transposition flap: a 20-year experience

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Facial Anatomy

Background:

• Major facial soft-tissue deformities present significant reconstructive challenges.
• Restoring facial function and aesthetics requires well-matched donor skin and consideration of unique facial characteristics.
• Current methods face limitations in addressing complex facial deficits.

Purpose of the Study:

• To present and evaluate an algorithm for total and subtotal facial reconstruction.
• To utilize the expanded shoulder transposition flap as a key element in facial reconstruction.
• To assess the reliability and outcomes of this algorithm over a 20-year period.

Main Methods:

• Development of a reconstructive algorithm centered on the expanded shoulder transposition flap.
• Application of the algorithm for head and neck resurfacing since 1986.
• Clinical evaluation of 58 expanded shoulder transposition flap procedures in 41 patients over 20 years.

Main Results:

• The algorithm demonstrated remarkable reliability and reproducibility in resurfacing facial aesthetic units.
• The expanded shoulder transposition flap effectively addressed peripheral facial defects.
• Pedicle skin from the flap was utilized for grafting central facial features, with primary closure of the donor site.

Conclusions:

• The developed algorithm using the expanded shoulder transposition flap is a versatile and reliable approach for major facial reconstruction.
• This method minimizes donor-site defects.
• The procedure is considered achievable for most reconstructive surgeons with adequate skill and patience.