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Published on: December 5, 2025
Cervicofacial advancement-rotation flap in midface reconstruction: forward or reverse?
Jennings R Boyette1, Emre Vural
1Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
Summary
This study shows that designing cervicofacial advancement-rotation flaps (CARFs) based on defect proportions effectively reconstructs midfacial defects. This method ensures minimal tension and optimal skin closure for satisfactory outcomes.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Facial Anatomy
Background:
- Midfacial defects pose reconstructive challenges.
- Cervicofacial advancement-rotation flaps (CARFs) are utilized for reconstruction.
- A standardized design method is needed for optimal CARF application in midfacial defects.
Purpose of the Study:
- To evaluate the authors' experience with CARF reconstruction for midfacial defects.
- To present a method for designing CARFs based on defect dimensions (forward vs. reverse).
- To assess the outcomes of this design strategy.
Main Methods:
- Retrospective case series of patients undergoing CARF reconstruction.
- Analysis focused on a subset of patients with midfacial defects.
- CARF design was determined by defect proportions: forward for larger vertical dimensions, reverse for larger horizontal dimensions.
Main Results:
- Thirteen patients with midfacial defects were analyzed.
- CARFs were used in a forward design (7 patients) and reverse design (6 patients).
- Reconstructions achieved satisfactory outcomes with no flap loss; mild ectropion in 6 patients was managed conservatively.
Conclusions:
- Designing CARFs based on the vertical and horizontal proportions of midfacial defects is effective.
- This approach minimizes tension during closure.
- It also reduces redundant skin at suture lines, improving aesthetic and functional results.