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A Method to Reproduce Symmetry in Midfacial Reconstruction: A Report of 19 Cases
Xiaoli Lou1, Chunyu Xue, Joseph A Molnar
1In the Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China, Xiaoli Lou, MD, PhD, is Attending Physician; and Chunyu Xue, MD, PhD, is Director. Joseph A. Molnar, MD, PhD, FACS, is Professor of Plastic and Reconstructive Surgery and Regenerative Medicine; Medical Director, Wound Care and Hyperbaric Center; and Associate Director, Burn Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina. Hongda Bi, MD, PhD, is Associate Professor, Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Background:
Reconstruction of facial skin defects remains a clinical challenge. With aging, ptosis of tissue over fixed structures creates an important facial feature known as the tear trough. This study aimed to evaluate the efficacy and aesthetic outcome of a novel surgical technique that reproduced this facial feature while avoiding ectropion during midfacial skin defect repair.
Methods:
Nineteen patients with midfacial skin defects received local flap reconstruction combined with an anchoring suture. The flap was designed in a unilateral pedicled V-Y pattern. When the flap was advanced to cover the defect, one or two sutures that connected the dermis of the flap with the infraorbital periosteum were made to reproduce the tear trough line.
Results:
Midfacial defects were successfully repaired with the V-Y flap in all 19 patients. No lower eyelid ectropion or conspicuous scars were noted in any of the patients. Further, the tear trough was successfully reconstructed in each patient. Facial symmetry was maintained with static positioning and animation.
Conclusions:
The combination of local V-Y flap reconstruction with anchoring sutures to reproduce facial feature lines is an effective technique in midfacial skin defect repair.
