The need for a complete platysma component for platysma myocutaneous flaps?--an introduction of the expanded cutaneous-dominant platysma flap for facial defect reconstruction.

Platysma flaps have been successfully used for the reconstruction of variety of facial defects as musculocutaneous. This concept had been changed by a recent anatomical investigation revealing the inherently fasciocutanous nature of the platysma flap. In the study, it was observed that all of the arterial branches furnishing the anterlateral neck skin penetrate the platysma but do not run along in the platysma layer. The switch made it possible for us to design cervical skin flaps with limited participation of muscular platysma composition in clinical practice. The platysma flap is considered to be an ideal donor source due to its thin, pliable and sufficient colour matched skin nature. When combined with the tissue expansion technique, this flap can provide adequate donor tissue that is particularly valuable for large facial defect repairs without leaving any modalities on the neck donor site. In our report, we designed and used the expanded platysma myocutaneous flap as a cutaneous-dominant skin flap for large facial defect repairs. In operation, the cervical flap is elevated at the intermediate layer between the platysma and the superficial adipofascia. A small amount platysma muscular tissue is recruited only in the area surrounding these facial artery perforators at the flap peddle region. As anticipated, the result was successful. We conclude that the expanded cutaneous-dominant platysma flap peddled by facial artery perforators provides a useful alternative for the reconstruction of facial defects and should be a valuable addition to facial reconstructive surgery.