Role of Glabellar flap in midfacial reconstruction.
Abstract
Aims: Reconstruction of midface always poses a challenge to a Plastic surgeon as one has to address the convexities and concavities which are somewhat unique to this area. Various local flaps have been used for achieving these goals. This study was conducted to evaluate the indications, feasibility and outcome of midfacial reconstruction using Glabellar flaps at a tertiary care center.
Materials and Methods: This is a prospective observational study conducted in the Department of Plastic and Reconstructive Surgery of a tertiary care hospital between January 2016 to December 2019. All the patients who underwent midfacial reconstruction with Glabellar flaps during this period and consented to be a part of this study were included. Patient demographics, wound etiology and area, flap size and its mode of transfer, number of surgeries required, type of anesthesia used, comorbid conditions, complications if any and the results of reconstruction were recorded. All the patients were followed up till May 2020.
Results: Thirteen patients were managed with Glabellar flaps. Majority of the patients (n=9, 69.23%) were males, with a mean age of 34 years. Most common cause of wounds was animal bite/maul (n=5, 38.46%). Glabellar flap was most commonly used as V-Y rotation advancement flap in nine patients (69.23%). Most of the cases (n=9, 69.23%) was operated under local anesthesia. Donor site was closed primarily in V-Y or linear fashion in 12 cases, and skin grafted only in 1 case. Majority (n=12, 92.3%) of the patients graded reconstruction results as Good-Excellent.
Conclusions: Glabellar flap is an excellent option for reconstruction of midfacial defects with minimal donor site morbidity and can be performed safely under local anesthesia.
Downloads
References
2. Özkaya Mutlu Ö, Egemen O, Dilber A, Üsçetin I. Aesthetic Unit-Based Reconstruction of Periorbital Defects. J Craniofac Surg. 2016 Mar;27(2):429–32.
3. Cerci FB. Usefulness of the subunit principle in nasal reconstruction. An Bras Dermatol. 2017;92(5 Suppl 1):159–62.
4. Stigall LE, Bramlette TB, Zitelli JA, Brodland DG. The Paramidline Forehead Flap: A Clinical and Microanatomic Study. Dermatol Surg. 2016 Jun;42(6):764–71.
5. Chiummariello S, Del Torto G, Iera M, Alfano C. The use of local flaps in the one-step nose reconstruction after cancer resection. Ann Ital Chir. 2013 Jul 2;84(ePub).
6. Kerem H, Bali U, Sönmez E, Manavbaşı YI, Yoleri L. The cranially based contralateral nasolabial flap for reconstruction of paranasal and periorbital surgical defects. J Plast Reconstr Aesthet Surg. 2014 May;67(5):655–61.
7. Baltu Y, Dölen UC, Aydin O. Extended Central Artery Perforator Propeller Flap for Large Nasal Defects. J Craniofac Surg. 2019 Dec;30(8):2408–11.
8. Field LM. The glabellar transposition “banner” flap. J Dermatol Surg Oncol. 1988 Apr;14(4):376–9.
9. Yildirim S, Aköz T, Akan M, Cakir B. The use of combined nasolabial V-Y advancement and glabellar flaps for large medial canthal defects. Dermatol Surg. 2001 Feb;27(2):215–8.
10. Emsen IM, Benlier E. The use of the superthinned inferior pedicled glabellar flap in reconstruction of small to large medial canthal defect. J Craniofac Surg. 2008 Mar;19(2):500–4.
11. Sanjuan-Sanjuan A, Ogledzki M, Ramirez CA. Glabellar Flaps for Reconstruction of Skin Defects. Atlas Oral Maxillofac Surg Clin North Am. 2020 Mar;28(1):43–8.
12. Koch CA, Archibald DJ, Friedman O. Glabellar flaps in nasal reconstruction. Facial Plast Surg Clin North Am. 2011 Feb;19(1):113–22.
13. Field LM. The use of a bipedicled flap for defects on the bridge of the nose. J Dermatol Surg Oncol. 1980 Mar;6(3):200–2.
14. Morrison WA, Donato RR, Breidahl AF, Theile DR, Callan PP. Island inner canthal and glabellar flaps for nasal tip reconstruction. Br J Plast Surg. 1995 Jul;48(5):263–70.
15. Seyhan T. The radix nasi island flap: a versatile musculocutaneous flap for defects of the eyelids, nose, and malar region. J Craniofac Surg. 2009 Mar;20(2):516–21.
16. Rieger RA. A local flap for repair of the nasal tip. Plast Reconstr Surg. 1967 Aug;40(2):147–9.
17. Marchac D. [The naso-frontal rotation flap]. Ann Chir Plast. 1970;15(1):44–9.
18. Choi JH, Kim YJ, Kim H, Nam SH, Choi YW. Distribution of Basal Cell Carcinoma and Squamous Cell Carcinoma by Facial Esthetic Unit. Arch Plast Surg. 2013 Jul;40(4):387–91.
19. Spinelli HM, Jelks GW. Periocular Reconstruction: A Systematic Approach. Plast Reconstr Surg. 1993 May;91(6):1017–1024.
20. Ogino A, Onishi K, Okada E, Nakamichi M. Medial canthal reconstruction with multiple local flaps. JPRAS Open. 2017;15:4‐9.
21. Onishi K, Maruyama Y, Okada E, Ogino A. Medial Canthal Reconstruction with Glabellar Combined Rintala Flaps. Plast Reconstr Surg. 2007 Feb;119(2):537–541.
22. Correa BJ, Weathers WM, Wolfswinkel EM, Thornton JF. The forehead flap: the gold standard of nasal soft tissue reconstruction. Semin Plast Surg. 2013;27(2):96‐103.
