Kite Flap in Facial Reconstructive Surgery

J.-L. DUCOURS

P. POIZAC

D. RICHARD

J. AFTIMOS

J. UNANUE

B. MARAUD

A. WANGERMEZ

C. ORRETEGUY

C. AUGUSTIN

The kite flap is a triangular cutaneous advancement flap with a subcutaneous pedicle. Vascularization is ensured by a segmental arterial network made up of vertical ascending branches that guarantee considerable security. The flap is relatively easy to transfer and yields excellent cosmetic results (1, 2).

INDICATIONS

Use of this flap is mainly in reconstructive facial surgery for repair of defects following excision of cutaneous tumors (3), preferentially in the cheek and in the suborbital and glabellar regions. Because the flap depends on linear sliding rather than rotation, distortion is reduced in adjacent areas, and the initial loss of substance in the defect can be distributed around the flap and along the V-Y closure. For extensive orbital tumors (4), external canthus loss near the eyelid edge (5), or scar ectropion requiring skin grafting (6), solutions other than the kite flap are necessary. This applies also to defects of the chin or upper lip.

ANATOMY

The area of the subcutaneous pedicle is not well defined, and its extent is greater than mere projection from the cutaneous plane would indicate. Mobilization of the cutaneous triangle of the kite flap requires a considerable amount of adjacent subcutaneous tissue. This increases flap vascularization and ensures greater ease of transfer. The pedicle is usually fatty but sometimes can be muscular, particularly in the suborbital region when pedicled on the orbicularis oculi muscle.

According to the arterial classification proposed by Kunert (7), the kite flap is a segmental flap based on ascending vessels from an axial network comprising longitudinal vessels that make the flap quite reliable (see Fig. 119.3). Venous return is modeled on the arterial network.

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