Reverse Cervicofacial Advancement-Rotation Flap (RCARF) for Midface and Cheek Reconstruction

Abstract

The cervicofacial advancement-rotation flap (CARF) is widely used for reconstruction of large midfacial cutaneous defects. It has a wide pedicle and can reach the supraorbital margin superiorly, can extend medially to the midline, and can include the postauricular skin posteriorly. The CARF consists of skin, subcutaneous fat, superficial neck veins, and the platysma muscle. The facial portion of the flap receives its blood supply from the subdermal plexus in a random pattern that consists of branches from the facial artery, transverse facial artery, and the superficial temporal artery via its orbito-zygomatic branch. The cervical portion of the flap receives its blood supply from the platysma via the preserved perforators of the submental artery. Venous outflow is provided mainly by the external jugular vein. Sensory innervation is provided by the branches of the greater auricular and lesser occipital nerves.