Burned Half-Cheek Resurfacing Techniques

Abstract

Scar deformities of the cheek pose a great challenge for surgeons due to the limited choice of well-matching donor skin. Distant tissues that can be transplanted in the form of a flap or skin graft do not match facial skin in color, elasticity, texture, or thickness. These grafts often appear as a mismatching patch of grafted skin in contrast to residual normal facial skin. Many flaps have been used for cheek reconstruction: cervico-facial flaps; cervico-pectoral flaps: regular, prefabricated, and expanded; supraclavicular; pectoral; shoulder and dorsal scapular flaps. For half-cheek resurfacing, neck skin matches facial skin better than any other donor site. But commonly used cervico-facial and cervico-pectoral flaps are known to be very delicate and often present with complications because of circulation insufficiency and tissue necrosis. Furthermore, operation scars deform the donor site—neck and chest. Tissue expansion broadens the possibilities of cheek resurfacing, but cervical skin expansion also carries a high rate of complications. After having treated many patients, half-cheek deformities can be classified into four basic forms and special surgical techniques have been developed for each of these forms. The anatomy and technique of reconstruction are presented in Chap. 6.