Cervicofacial Skin Flap to The Cheek

EDITORIAL COMMENT

This flap should be compared with that described in Chapter 114 because there are some similarities.

The cervicofacial flap involves the lower cheek and upper neck. It is based laterally not medially, as is usually described (1).

INDICATIONS

The cervicofacial flap is particularly suitable for patients who are middle-aged or older because of the laxity of the cervical skin that allows a primary closure of the donor area. It has been used without difficulty in younger patients; however, a skin graft may be required in the neck to prevent excessive pulling on the lower lid. The flap can be used, with or without lining, for closure of a cheek defect that also requires a radical neck dissection because the opening on the neck can be approximated without resorting to a distant flap. In my experience, this flap has its greatest usefulness for closure of cheek defects ranging from 4 × 4 cm to 6 × 7 cm.

ANATOMY

Although random, the cervicofacial skin flap is richly supplied, primarily by the external maxillary artery and vein and their branches. It is not necessary to include the platysma for blood supply.

FLAP DESIGN AND DIMENSIONS

No flap delaying procedure is required. The skin portion of this laterally based flap usually measures 9.5 cm wide at its base and 12 cm long.

OPERATIVE TECHNIQUE

Flap dissection on the cheek usually follows or parallels the nasolabial fold and then goes across the mandible down to the midcervical region or lower, where dissection is maintained superficial to the platysma muscle to avoid injury to the mandibular branch of the facial nerve. In the midneck, the flap is cut transversely to a point over the sternocleidomastoid muscle and then superiorly and posteriorly to the earlobe or mastoid area.

If the flap is rotated into the lower eyelid, it is advisable to anchor it to the deep tissues of the orbit and the nose to avoid ectropion from its weight. Similarly, the excision should be carried laterally beyond and above the outer canthus onto the temporal region, where the flap also can be fastened to provide a supportive sling under the lower lid.

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