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.
Figure 1: BCC Left medial canthus.
Figure 2: Defect following resection of the lesion.
Figure 3: Marking of flap.
Figure 4: Identification of angular artery red arrow shows angular artery.
Figure 5: Delay of flap.
Figure 6: Insetting of flap.
Figure 7: Congestion of the flap.
Figure 8: 1 week follow up.
Figure 9: 2 weeks follow up.
Figure 10: 3 months follow up.
Figure 11: 6 months follow up.
Figure 12: 6 months follow up.
Figure 13: BCC of Left medial canthus & upper eyelid.
Figure 14: Defect after excision with flap marking arrow showing exposed bone.
Figure 15: Flap elevation.
Figure 16: Flap insetting.
Figure 17: Follow up 2 week.
Figure 18: 4 weeks follow up.
Figure 19: 3 months follow up.
Figure 20: 6 months follow up.
Figure 21: BBCC near Right medial canthus.
Figure 22: Excision of the lesion.
Figure 23: Elevation of flap.
Figure 24: Insetting of flap.
Figure 25: Follow up of 2 weeks.
Figure 26: 4 Weeks follow up.
Figure 27: 3 months follow up.
Figure 28: 6 months follow up.
Figure 29: SCC Right medial canthus & adjacent lateral nasal wall.
Figure 30: Excision of lesion with nasal bone removal arrow shows removed bone.
Figure 31: 4 weeks follow up.
Figure 32: 6 months follow up.
Figure 33: BCC Left infraorbital region.
Figure 34: Defect after excision.
Figure 35: Shows reach of flap over forehead.
Figure 36: Shows reach of flap over forehead.
Figure 37: Reach go upto ipsilateral lateral canthus.
Figure 38: Shows reach of flap to nasal tip.
Figure 39: Reach of angular island flap contralateral upper eyelid.
Figure 40: Insetting of flap.
Figure 41: After maxillectomy defect covered with angular artery island flap.
Figure 42: After maxillectomy defect covered with angular artery island flap.
