Subcutaneous island pedicle flap - Variations and versatility for facial reconstruction

Purpose: Reconstruction of facial skin defects may be a clinical challenge in respect to esthetic considerations, and the V-Y advancement island pedicle flap has been a versatile and reliable method. Besides the V-Y flap, this article is to introduce the variations of subcutaneous island pedicle flaps and their versatility for facial reconstruction. Methods: From August 1994 to August 2005, 179 cases of medium-sized facial skin defects within I cosmetic unit were reconstructed with the variations of island pedicle flaps, and the length and width of the defects following removal of lesion ranged from 1.2 cm x 0.8 cm to 6.2 cm x 5.4 cm. Results: Ninety-nine facial defects all over the face were reconstructed with the V-Y flaps, and the traditional and modified transposition island pedicle flaps were used to reconstruct 80 cases of relatively larger width of defects in the nose, lip, and upper cheek, especially in the young patients. Through careful planning and implementation, all flaps survived with primary healing postoperatively. With a follow-up from 6 to 30 months, well-concealed, soft, flat scars, together with good matching of the recipient sites and the flaps, were recorded. Patients and surgeons judged final overall outcome as excellent or good in 94.4% and 92.2% of evaluated patients, respectively. The main complications included visible trap-door deformation in 9 patients, bulky flap pedicle in 8 patients, and low-grade ectropion of lower eyelid in a young boy, which all were readily revised at the second stage. Temporary alteration of sensation in the flap skin was another possible complication but usually improved with time. Conclusions: Variations of subcutaneous island pedicle flaps can be designed and may be versatile and reliable methods for esthetic reconstruction of medium-sized facial defects.