Application of a Modified Perforator Flap of the Transverse Facial Artery for Zygomaticofacial Skin Defect Repair After Tumor Resection

Abstract

Background: The transverse facial artery is an important source of zygomaticofacial blood, but its perforator flap is rarely reported. The aim of this study was to investigate the utility of a modified perforator flap based on facial aesthetic units and previous anatomic studies of transverse facial arteries. Methods: All 18 elderly patients with zygomatic facial tumors underwent Mohs surgery. The V-Y and propeller flaps were designed according to the aesthetic unit of the defect site. Only a small portion of the fascia and fat surrounding the blood vessel are left, the rest of the flap is pruned to a thickness closer to the surrounding tissues. The surgical effect was comprehensively evaluated by an expert group. To assess the patient’s postoperative quality of life, we administered the FACT-H & N (v 4.0) scale before and after surgery. Results: Among the 18 flaps, 10 were V-Y flaps and 8 were propeller flaps. The flaps of 18 patients survived, with adequate cheek, facial symmetry, and proper mouth opening. The flaps worked well and looked good at both the recipient and donor sites. According to the scale survey, the postoperative patients had a higher quality of life in terms of physiology, psychology, function, and other areas than the preoperative patients (P<0.05). Conclusion: A modified flap of the transverse facial artery can rotate flexibly and repair a larger area, as the blood flow is relatively constant near the zygomatic arch. It has a high clinical value in the treatment of zygomaticofacial tumors.