Case Report - Clinical Practice (2017) Volume 14, Issue 1

A longitudinal study of angular artery island flap, used for reconstruction of facial defects

Corresponding Author:
Arghya Bera
RGKAR Medical College Kolkata
West Bengal India
E-mail: drarghyabera7@gmail.com

Abstract

Considering cosmetic and functional outcome, reconstruction of moderate to large mid & upper facial soft-tissue defects due to trauma, neoplasm, or infection remains a challenge. We used either ipsilateral or contralateral angular artery island flap in patients with full-thickness soft-tissue defects in those areas. We present our experience in 30 patients (17 females & 13 males) with mean age of 65 , with complex soft-tissue defects in mid & upper face reconstructed with angular artery island flaps. Defect sizes changed from 1 × 2 cm to3.5 × 5 cm. Flap size varied from a length of 2.2 to 6 cm average (average 4 cm) and width of 2.7 to 6.5 cm (average 5 cm). All donor sites were closed primarily. Twenty seven flaps (90%) healed without any necrosis and completely survived. Ipsilateral or contralateral angular artery island flap is a very convenient, safe and reliable flap for reconstruction of moderate to large mid and upper facial defects. Good aesthetic outcome for variety of facial defects could be obtained with this flap. Donor site morbidity also less.

Keywords

mid and upper facial defect, angular artery island flap, ipsilateral or contralateral, local flap, donor area

Introduction

Considering cosmetic and functional outcome, reconstruction of moderate to large mid & upper facial soft-tissue defects due to trauma, neoplasm, or infection remains a challenge. We used either ipsilateral or contralateral angular artery island flap in patients with full-thickness soft-tissue defects in those areas.

We present our experience in 30 patients (17 females & 13 males) with mean age of 65 , with complex soft-tissue defects in mid & upper face reconstructed with angular artery island flaps. Defect sizes changed from 1 × 2 cm to3.5 × 5 cm.

Flap size varied from a length of 2.2 to 6 cm average (average 4 cm) and width of 2.7 to 6.5 cm (average 5 cm). All donor sites were closed primarily. Twenty seven flaps (90%) healed without any necrosis and completely survived.

Ipsilateral or contralateral angular artery island flap is a very convenient, safe and reliable flap for reconstruction of moderate to large mid and upper facial defects. Good aesthetic outcome for variety of facial defects could be obtained with this flap. Donor site morbidity also less.

Age range (years) Number
31-40 1
41-50 2
51-60 6
61-70 9
71-80 9
>80 3

Table 1: Age distribution.

Sex Number
Male 13
Female 17

Table 2: Sex distribution

Diabetes Number
Yes 9
No 21

Table 3: Diabetes.

Lesion Number
BCC 18
SCC 12

Table 4: Nature of lesion.

Site Number
Paranasal 1
Infra orbital 6
 Medial canthus 8
Malar region 6
Nasal dorsum 4
Nasal tip 2
Glabella 1
Nasal ala 2

Table 5: Site of lesions.

Length (cm) Breadth (cm)
Minimum Maximum Minimum Maximum
1 4.5 1.5 5

Table 6: Size of lesions.

Length (cm) Breadth (cm)
Minimum Maximum Minimum Maximum
2 5.5 2 6

Table 7: Size of defects.

Length (cm) Breadth (cm)
Minimum Maximum Minimum Maximum
2.2 6 2.7 6.5

Table 8: Size of flaps.

Maximum (mins) Minimum (mins) Mean
120 70 89.17

Table 9: Operative time-time required to create defect, raise flap & inset of flap.

Maximum (days) Minimum (days) Mean
27 6 12.50

Table 10: Post-operative hospital stay.

Complication Number
No complication 23
Partial necrosis 3
Bulky 2
Haematoma 1
Ectropion 1

Table 11: Complication.

Smoking Complication No complication p value
Yes 3 8 0.698
No 4 15

Table 12: Relation between flap survival and smoking.

Diabetes Complication No complication p value
Yes 3 6 .397
No 4 17

Table 13: Relation between flap survival and Diabetes.

Null Hypothesis Test Sig. Decision
The distribution of Flap_L is
the same across categories
of Complication_New.
Independent-Samples
Mann-Whitney U Test
0.0541 Retain the null hypothesis.
The distribution of Flap_B is
the same across categories
of Complication_New.
Independent-Samples
Mann-Whitney U Test
0.0271 Retain the null hypothesis.
Asymptotic significances are displayed. The significance level is 0.05.
1Exact significance is displayed for this test.

Table 14: Relation between flap dimension and complication

Best outcome Worst outcome Mean outcome
6 14 8.6

Table 15: Facial aesthetics.

clinical-practice-medial-canthus

Figure 1: BCC Left medial canthus.

clinical-practice-Defect-following

Figure 2: Defect following resection of the lesion.

clinical-practice-Marking-flap

Figure 3: Marking of flap.

clinical-practice-angular-artery

Figure 4: Identification of angular artery red arrow shows angular artery.

clinical-practice-Delay-flap

Figure 5: Delay of flap.

clinical-practice-Insetting-flap

Figure 6: Insetting of flap.

clinical-practice-Congestion-flap

Figure 7: Congestion of the flap.

clinical-practice-1-week

Figure 8: 1 week follow up.

clinical-practice-2-week

Figure 9: 2 weeks follow up.

clinical-practice-3-week

Figure 10: 3 months follow up.

clinical-practice-6-week

Figure 11: 6 months follow up.

clinical-practice-6-week

Figure 12: 6 months follow up.

clinical-practice-Left-medial

Figure 13: BCC of Left medial canthus & upper eyelid.

clinical-practice-Defect-after

Figure 14: Defect after excision with flap marking arrow showing exposed bone.

clinical-practice-Flap-elevation

Figure 15: Flap elevation.

clinical-practice-Flap-insetting

Figure 16: Flap insetting.

clinical-practice-2-week

Figure 17: Follow up 2 week.

clinical-practice-4-week

Figure 18: 4 weeks follow up.

clinical-practice-4-months

Figure 19: 3 months follow up.

clinical-practice-6-months

Figure 20: 6 months follow up.

clinical-practice-BBCC-near

Figure 21: BBCC near Right medial canthus.

clinical-practice-Excision-lesion

Figure 22: Excision of the lesion.

clinical-practice-Elevation-flap

Figure 23: Elevation of flap.

clinical-practice-Insetting-flap

Figure 24: Insetting of flap.

clinical-practice-2-weeks

Figure 25: Follow up of 2 weeks.

clinical-practice-4-weeks

Figure 26: 4 Weeks follow up.

clinical-practice-3-months

Figure 27: 3 months follow up.

clinical-practice-6-months

Figure 28: 6 months follow up.

neuropsychiatry

Figure 29: SCC Right medial canthus & adjacent lateral nasal wall.

clinical-practice-removal-arrow

Figure 30: Excision of lesion with nasal bone removal arrow shows removed bone.

clinical-practice-4-weeks

Figure 31: 4 weeks follow up.

clinical-practice-6-months

Figure 32: 6 months follow up.

clinical-practice-BCC-Left

Figure 33: BCC Left infraorbital region.

neuropsychiatry

Figure 34: Defect after excision.

neuropsychiatry

Figure 35: Shows reach of flap over forehead.

clinical-practice-flap-over

Figure 36: Shows reach of flap over forehead.

clinical-practice-lateral-canthus

Figure 37: Reach go upto ipsilateral lateral canthus.

clinical-practice-flap-nasal

Figure 38: Shows reach of flap to nasal tip.

clinical-practice-upper-eyelid

Figure 39: Reach of angular island flap contralateral upper eyelid.

clinical-practice-Insetting-flap

Figure 40: Insetting of flap.

clinical-practice-maxillectomy-defect

Figure 41: After maxillectomy defect covered with angular artery island flap.

clinical-practice-angular-artery

Figure 42: After maxillectomy defect covered with angular artery island flap.