Reconstruction of the Face by Means of the Angle-Rotation Flap

看书的时候发现的两篇文献(¹)(²)，提出的angle-rotation flap用于颊部皮肤缺损的修复确实是一个很好的方法。

面部皮肤组织的缺损，由于对皮肤颜色质地等的要求比较高，邻位皮瓣往往是最佳的修复选择，比如常用的双叶瓣(bilobed flap)、面颈旋转瓣或颈胸旋转瓣。

这两篇文献中提出的angle-rotation flap与前述邻位瓣设计方案相比，瘢痕更加隐蔽。

angle-rotation flap可用于颊部及下眼睑皮肤缺损的修复。对于面积较大的缺损，可通过多次应用angle-rotation flap来进行分次切除和修复，Schrudde认为同一个angle-rotation flap可反复应用达三次（每次应用期间间隔6-12个月等待瘢痕成熟）；或通过皮肤扩张器来增加皮肤的量从而一次完成修复。

皮瓣设计方式大致如图(来自文献1)：

Boutros等给出了更详细的技术细节（自己先过了一遍，然后用GPT-4进行了总结，总的比较到位）：
The angle rotation flap is a specialized technique used in reconstructive surgery, particularly for addressing cheek and eyelid defects. Here’s a step-by-step summary of the flap design and preparation process:

图片来自文献2：

Flap Design and Preparation Steps:

1. Design Outline:

   • Begin with marking the posterior edge of the cheek or eyelid excision.
   • Extend the marking straight back towards the hairline, ensuring the distance is similar to the horizontal length of the defect. This step may include tissue expansion for better fit.
   • Direct the design towards the tragus, taking care not to advance hair-bearing areas on women.
   • The incision is made along the anterior edge of the ear, continuing under the lobule with an advancement angle designed behind the ear, usually between 60 and 90 degrees.

2. Flap Elevation:

   • The entire flap is elevated, typically below the submuscular aponeurotic system starting from the middle part of the parotid gland, especially in cases with large defects or potential tension.
   • For smaller defects, the flap can be elevated more superficially.
   • After elevation, the flap is resuspended beginning near the lobule, effectively closing the “angle” and rotating the flap into place.
   • The flap is then anchored using bone anchors placed at strategic points like the lateral orbital rim and below the arcus marginalis to prevent downward pull.

3. Incorporation of Tissue Expansion:

   • In cases requiring larger adjustments or in pediatric cases, a tissue expander is placed adjacent to the defect through a preauricular incision.
   • Expansion is performed progressively every 5 to 7 days beginning one week post-operation.
   • This step is essential for avoiding deep plane elevation when extensive expansion is utilized.

4. Securing and Final Adjustments:

   • Specific areas of the flap and surrounding tissue are secured with sutures and bone anchors to ensure proper placement and tension distribution.
   • If used, tissue expanders are adjusted or removed according to the expansion plan.

5. Post-operative Care:

   • Continuous monitoring and adjustment of the flap tension and position to ensure optimal healing and defect coverage.

These steps highlight the detailed and methodical approach required to successfully implement the angle rotation flap in reconstructive surgery. This technique is favored for its dual ability to rotate and elevate, providing a significant aesthetic and functional benefit, particularly in the delicate areas of the cheek and eyelids.

1. Schrudde J, Beinhoff U. Reconstruction of the face by means of the angle-rotation flap. Aesthetic Plast Surg. 1987;11(1):15-22. doi: 10.1007/BF01575477. PMID: 3577939. ↩

2. Boutros S, Zide B. Cheek and eyelid reconstruction: the resurrection of the angle rotation flap. Plast Reconstr Surg. 2005 Oct;116(5):1425-30; discussion 1431-3. doi: 10.1097/01.prs.0000182399.45538.f9. PMID: 16217489. ↩