Büyük Yanak Defektlerinin Rekonstrüksiyonu
Özet
Büyük yanak defektlerinin rekonstrüksiyonu; bölgenin estetik, üç boyutlu topografik ve fonksiyonel özellikleri nedeniyle hassas bir cerrahi yaklaşım gerektirir. Yanak defektleri sıklıkla cilt tümör cerrahisi veya travma sonrası meydana gelir. Rekonstrüksiyonda temel amaç fonksiyonların korunması, estetik görünümün normale en yakın hale getirilmesi ve morbiditenin en aza indirilmesidir. Defektlerin boyutuna ve yerleşimine göre farklı flep seçenekleri tercih edilmektedir. Küçük ve orta büyüklükteki defektlerde lokal flepler (anterior/posterior tabanlı servikofasyal flepler) kullanılırken, daha geniş lezyonlarda lokorejyonel (servikopektoral) veya bölgesel flepler (platisma muskulokutanöz, supraklavikuler, deltopektoral flepler) tercih edilmektedir. Platisma fleplerinde venöz konjesyon ve nekroz gibi riskler bulunurken, omuz bölgesinden alınan pediküllü flepler renk ve doku uyumu açısından avantaj sağlar. Son yıllarda, mikrovaskuler cerrahinin gelişmesiyle özellikle kemik ve orbitanın açıkta olduğu kompleks transvers defektlerde serbest flepler (radial önkol, anterolateral uyluk vb.) ilk seçenek haline gelmiştir. Serbest flepler güvenilir vaskülarizasyon sağlasa da renk ve kalınlık uyumsuzluğu ile doku kaybı gibi komplikasyon riskleri barındırır. Sonuç olarak, en uygun rekonstrüksiyon yöntemi; defektin lokalizasyonu, boyutu, alıcı sahanın durumu ve cerrahın deneyimine göre belirlenir.
The reconstruction of large cheek defects requires a precise surgical approach due to the region's aesthetic, three-dimensional topographic, and functional characteristics. Cheek defects frequently occur following skin tumor surgery or trauma. The primary goal in reconstruction is to preserve functions, restore the aesthetic appearance as close to normal as possible, and minimize morbidity. Different flap options are preferred depending on the size and location of the defects. Local flaps (anterior/posterior-based cervicofascial flaps) are utilized for small and medium-sized defects, whereas locoregional (cervicopectoral) or regional flaps (platysma myocutaneous, supraclavicular, deltopectoral flaps) are preferred for larger lesions. While platysma flaps carry risks such as venous congestion and necrosis, pedicled flaps harvested from the shoulder region offer advantages in color and texture match. In recent years, with the advancement of microvascular surgery, free flaps (radial forearm, anterolateral thigh, etc.) have become the first choice, especially in complex transverse defects where bone and orbit are exposed. Although free flaps provide reliable vascularization, they carry risks of complications such as color and thickness mismatch, as well as tissue loss. Consequently, the most appropriate reconstruction method is determined based on the localization and size of the defect, the condition of the recipient site, and the surgeon's experience.
Referanslar
González-Ulloa M. Restoration of the face covering by means of selected skin in regional ˦sthetic units. British Journal of Plastic Surgery. 1956;9. doi:10.1016/S0007-1226(56)80036-2
Thompson S, Menick FJ. Aesthetic facial reconstruction: Blending human perception and the facial subunit theory. Plastic Surgical Nursing. 1994;14(4). doi:10.1097/00006527-199401440-00004
Menick FJ. Artistry in aesthetic surgery. Aesthetic perception and the subunit principle. Clinics in plastic surgery. 1987;14(4). doi:10.1016/S0094-1298(20)31498-X
Fattahi TT. An overview of facial aesthetic units. Journal of Oral and Maxillofacial Surgery. 2003;61(10): 1207–1211. doi:10.1016/S0278-2391(03)00684-0
Mureau MAM, Hofer SOP. Maximizing Results in Reconstruction of Cheek Defects. Clinics in Plastic Surgery. Elsevier Ltd; 2009;36(3): 461–476. doi:10.1016/j.cps.2009.02.003
Mendelson BC, Jacobson SR. Surgical Anatomy of the Midcheek: Facial Layers, Spaces, and the Midcheek Segments. Clinics in Plastic Surgery. 2008;35(3): 395–404. doi:10.1016/j.cps.2008.02.003
Marur T, Tuna Y, Demirci S. Facial anatomy. Clinics in Dermatology. Elsevier Inc.; 2014;32(1): 14–23. doi:10.1016/j.clindermatol.2013.05.022
Burget GC, Menick FJ. The subunit principle in nasal reconstruction. Plastic and Reconstructive Surgery. 1985;76(2). doi:10.1097/00006534-198508000-00010
Kuehnemund M, Bootz F. Reconstruction of the cheek. Facial Plastic Surgery. 2011;27(3). doi:10.1055/s-0031-1275778
JFS. E. Rotation der Wange. Leipzig; 1918.
Juri J, Juri C. Advancement and rotation of a large cervicofacial flap for cheek repairs. Plastic and Reconstructive Surgery. 1979;64(5). doi:10.1097/00006534-197964050-00015
Menick FJ. Reconstruction of the cheek. [Online] Plastic and Reconstructive Surgery. 2001. doi:10.1097/00006534-200108000-00033
Kroll SS, Reece GP, Robb G, et al. Deep-plane cervicofacial rotation-advancement flap for reconstruction of large cheek defects. Plastic and Reconstructive Surgery. 1994;94(1). doi:10.1097/00006534-199407000-00008
Purnell CA, Bricker JT, Alghoul MS. Pushing the limits in cheek reconstruction: The sub-superficial musculo-aponeurotic system ⇘⇘deep plane⇔⇔ cervicofacial flap for reconstruction of large eyelid-cheek junction defects. [Online] Journal of Craniofacial Surgery. 2020. doi:10.1097/SCS.0000000000006500
Chakraborty SS, Kotu S, Sahu RK, et al. Reconstruction of a Large Traumatic Medial Cheek Defect Using an Anterior-Based Subcutaneous Cervicofacial Rotation Advancement Flap. Plastic Surgical Nursing. 2021;41(2). doi:10.1097/PSN.0000000000000361
Boutros S, Zide B. Cheek and eyelid reconstruction: The resurrection of the angle rotation flap. Plastic and Reconstructive Surgery. 2005;116(5). doi:10.1097/01.prs.0000182399.45538.f9
17 Cheek Reconstruction. Reconstructive Plastic Surgery. 2021. doi:10.1055/b-0041-183155
Snapp WK, Liu P. Lip and Cheek Reconstruction. Tips and Tricks in Plastic Surgery. 2022. doi:10.1007/978-3-030-78028-9_16
Rostom A, Dubé C, Cranney A, et al. The diagnostic accuracy of serologic tests for celiac disease: A systematic review. Gastroenterology. 2005;128(4): S38–S46. doi:10.1053/j.gastro.2005.02.028
Garrett WS, Giblin TR, Hoffman GW. Closure of skin defects of the face and neck by rotation and advancement of cervicopectoral flaps. Plastic and Reconstructive Surgery. 1966;38(4). doi:10.1097/00006534-196610000-00008
Hayashi T, Yamamoto Y, Oyama A, et al. Reconstruction of Large Cheek Defect With/Without Sideburn Using Malar-Posterior Auricular-Cervico Flap. Annals of Plastic Surgery. 2016;77(2): 173–177. doi:10.1097/SAP.0000000000000575
Futrell JW, Johns ME, Edgerton MT, et al. Platysma myocutaneous flap for intraoral reconstruction. The American Journal of Surgery. 1978;136(4). doi:10.1016/0002-9610(78)90270-2
Puxeddu R, Dennis S, Ferreli C, et al. Platysma myocutaneous flap for reconstruction of skin defects in the head and neck. British Journal of Oral and Maxillofacial Surgery. 2008;46(5). doi:10.1016/j.bjoms.2007.11.015
Peng LW, Zhang WF, Zhao JH, et al. Two designs of platysma myocutaneous flap for reconstruction of oral and facial defects following cancer surgery. International Journal of Oral and Maxillofacial Surgery. 2005;34(5). doi:10.1016/j.ijom.2004.10.022
Agarwal A, Schneck CD, Kelley DJ. Venous drainage of the platysma myocutaneous flap. Otolaryngology - Head and Neck Surgery. 2004;130(3). doi:10.1016/j.otohns.2003.12.005
Mütter TD. Cases of Deformity from Burns, relieved by Operation. The American Journal of the Medical Sciences. 1842;4(7). doi:10.1097/00000441-184207000-00005
Lamberty BGH. The supra-clavicular axial patterned flap. British Journal of Plastic Surgery. 1979;32(3). doi:10.1016/S0007-1226(79)90033-X
Pallua N, Noah EM. The tunneled supraclavicular island flap: An optimized technique for head and neck reconstruction. Plastic and Reconstructive Surgery. 2000;105(3). doi:10.1097/00006534-200003000-00003
Hartman EHM, Van Damme PA, Sauter H, et al. The use of the pedicled supraclavicular flap in noma reconstructive surgery. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2006;59(4). doi:10.1016/j.bjps.2005.10.005
Ragbir M, Ali T, Ramdass MJ, et al. Pedicled flaps in reconstructive surgery. West Indian Medical Journal. 2002;51(2).
Bakamjian VY. A two-stage method for pharyngoesophageal reconstruction with a primary pectoral skin flap. Plastic and Reconstructive Surgery. 1965;36(2). doi:10.1097/00006534-196508000-00004
Jowett N, Mlynarek AM. Reconstruction of cheek defects: A review of current techniques. Current Opinion in Otolaryngology and Head and Neck Surgery. 2010;18(4): 244–254. doi:10.1097/MOO.0b013e32833a6d7f
Ma ZC, Sun LB, Zhou HY. [Clinical application of folded free radial forearm flaps for reconstruction of full-tickness cheek defects after resection of buccal carcinoma]. Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery. 2018;32(13). doi:10.13201/j.issn.1001-1781.2018.13.010
Cordeiro PG, Santamaria E. Free flap reconstruction of the cheek. Operative Techniques in Plastic and Reconstructive Surgery. 1999;6(4): 265–274. doi:10.1016/s1071-0949(99)80007-9
Janik S, Eljazzar R, Faisal M, et al. Outcome in patients with partial and full-thickness cheek defects following free flap reconstruction—a multicentric analysis of 47 cases. Journal of Clinical Medicine. 2020;9(6). doi:10.3390/jcm9061740
Jeng SF, Kuo YR, Wei FC, et al. Reconstruction of concomitant lip and cheek through-and-through defects with combined free flap and an advancement flap from the remaining lip. Plastic and Reconstructive Surgery. 2004;113(2). doi:10.1097/01.PRS.0000100809.43453.C7
Huang WC, Chen HC, Jain V, et al. Reconstruction of through-and-through cheek defects involving the oral commissure, using chimeric flaps from the thigh lateral femoral circumflex system. Plastic and Reconstructive Surgery. 2002;109(2). doi:10.1097/00006534-200202000-00003
