Daojiang Yu1, Shikun Cao1, Shuyu Zhang2,3. 1. Department of Plastic Surgery, the Second Affiliated Hospital of Soochow University. 2. School of Radiation Medicine and Protection, Medical College of Soochow University. 3. State Key Lab of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, China.
Abstract
BACKGROUND: The single-stage reconstruction of large facial defects remains a conundrum due to the balance between function and aesthetics after skin cancer radical resection. OBJECTIVE: The goal of this study was to explore a novel surgical procedure for large facial defects that not only resurfaces the large defect in single stage but also improves aesthetic outcomes for both defects and donor sites. METHODS: The reconstructions were performed using local flaps in the form of a "jigsaw puzzle" flap based on a freestyle perforator and facial aesthetic unit. This procedure starts with a Doppler signal of the perforator and proceeds sequentially in conjunction with adjacent flaps, similar to fitting puzzle pieces, to create a new, large, jigsaw puzzle-like flap that complies with the concept of a facial aesthetic unit. All defects achieved tensionless primary closure with suturing in a concealed area. RESULTS: Procedures were performed for 40 patients; the average size of the defects was 37 cm (range, 6-51 cm). The patients were followed up for a range of 6 months to 2 years, and reconstruction without flap loss was 100% successful. CONCLUSION: Via a jigsaw puzzle flap based on a freestyle perforator and an aesthetic unit, we can take advantage of a greater freedom of flap selection and have a more versatile aesthetic design. The jigsaw puzzle flap concept represents a safe and favorable approach to the reconstruction of large facial defects.
BACKGROUND: The single-stage reconstruction of large facial defects remains a conundrum due to the balance between function and aesthetics after skin cancer radical resection. OBJECTIVE: The goal of this study was to explore a novel surgical procedure for large facial defects that not only resurfaces the large defect in single stage but also improves aesthetic outcomes for both defects and donor sites. METHODS: The reconstructions were performed using local flaps in the form of a "jigsaw puzzle" flap based on a freestyle perforator and facial aesthetic unit. This procedure starts with a Doppler signal of the perforator and proceeds sequentially in conjunction with adjacent flaps, similar to fitting puzzle pieces, to create a new, large, jigsaw puzzle-like flap that complies with the concept of a facial aesthetic unit. All defects achieved tensionless primary closure with suturing in a concealed area. RESULTS: Procedures were performed for 40 patients; the average size of the defects was 37 cm (range, 6-51 cm). The patients were followed up for a range of 6 months to 2 years, and reconstruction without flap loss was 100% successful. CONCLUSION: Via a jigsaw puzzle flap based on a freestyle perforator and an aesthetic unit, we can take advantage of a greater freedom of flap selection and have a more versatile aesthetic design. The jigsaw puzzle flap concept represents a safe and favorable approach to the reconstruction of large facial defects.