Subunit Reconstruction With Local and Regional Flaps of a Total Cervicofacial Defect From Necrotizing Fasciitis

Area of Science:

• Plastic Surgery
• Head and Neck Reconstruction
• Reconstructive Microsurgery

Background:

• Necrotizing fasciitis can result in extensive cervicofacial defects requiring complex reconstruction.
• Large-scale tissue loss in the head and neck presents significant reconstructive challenges, impacting function and aesthetics.

Observation:

• A 60-year-old female patient presented with a ∼450 cm² defect involving the orbit, malar, buccal, labial, submental, forehead, nasal sidewall, and anterolateral neck following necrotizing fasciitis.
• Reconstruction utilized a combination of supraclavicular, deltopectoral, forehead rotational, and labial advancement flaps, along with orbital skin grafting.

Findings:

• The multi-flap reconstruction achieved complete flap survival at 2-month follow-up.
• The patient reported high satisfaction with her appearance and regained comparable premorbid speech and oral function.
• Subunit reconstruction with local and regional flaps demonstrated efficacy in addressing extensive head and neck defects.

Implications:

• Meticulous surgical planning is crucial for successful reconstruction of large head and neck defects.
• Local and regional flap-based subunit reconstruction offers a viable alternative to free tissue transfer, potentially yielding superior functional and aesthetic results in select cases.
• This case highlights the potential for restoring both form and function in patients with severe cervicofacial defects.