Midface soft tissue reconstruction with the facio-cervico-pectoral flap

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Head and Neck Surgery

Background:

• Reconstructing large soft tissue defects in the orbital and maxillomalar region presents significant functional and aesthetic challenges.
• Achieving optimal outcomes requires careful consideration of flap choice, patient factors, and defect size.

Purpose of the Study:

• To evaluate the efficacy of the cervicopectoral rotation flap, often in conjunction with the temporalis myofascial flap, for reconstructing extensive soft tissue defects in the midface and orbital regions.
• To highlight the advantages of these pedicled flaps over microsurgical free flaps for specific patient populations.

Main Methods:

• Retrospective review of 22 patients undergoing reconstruction for large soft tissue defects in the maxillomalar and orbital areas over an 8-year period.
• Utilized the facio-cervico-pectoral rotation flap and temporalis myofascial flap as primary reconstructive tools.
• Compared outcomes with alternative reconstructive methods, including microsurgical free flaps.

Main Results:

• The cervicopectoral rotation flap demonstrated ease of harvest, safety, and compatibility with adjuvant therapies like radiotherapy.
• This pedicled flap provided favorable functional and aesthetic results, especially in elderly patients with midface defects.
• In cases of orbital exenteration, combined use with the temporalis myofascial flap proved effective.

Conclusions:

• The facio-cervico-pectoral rotation flap is a preferred pedicled flap for large midface soft tissue defects, offering a balance of simplicity and efficacy.
• These pedicled flaps provide comparable or superior functional and aesthetic results to more complex microsurgical techniques, with potentially lower morbidity.
• The temporalis myofascial flap serves as a valuable adjunct for orbital reconstructions.