Name of the Procedure:

Midface flap (ie, zygomaticofacial flap) with preservation of vascular pedicle(s)

Summary

The midface flap procedure, also known as the zygomaticofacial flap, is a surgical technique used to repair or reconstruct areas of the midface. This procedure involves preserving the blood supply (vascular pedicle) to ensure the viability of the tissue being repositioned.

Purpose

The procedure addresses facial defects or trauma, such as those resulting from injury, cancer surgery, or congenital anomalies. The aims are to restore the structural integrity and aesthetic appearance of the midface, enhancing both function and appearance.

Indications

• Facial trauma or injuries
• Surgical resections due to cancer
• Congenital facial deformities
• Severe facial scarring or defects
• Inadequate healing from previous facial surgeries

Preparation

• Fasting for at least 8 hours before the procedure
• Adjusting or stopping certain medications as advised by the healthcare provider
• Preoperative imaging studies (e.g., CT scans)
• Blood tests and overall health assessments

Procedure Description

1. Administration of anesthesia, usually general.
2. Careful marking of the surgical area.
3. An incision is made in the zygomatic region (cheekbone area).
4. The tissue flap, connected by its vascular pedicle, is carefully elevated and repositioned to cover the defect.
5. The flap is sutured into place, ensuring adequate blood flow through the preserved vascular pedicle.
6. The donor site is closed, often with additional tissue grafting for better healing.
7. Any necessary reconstructive techniques are employed to enhance the cosmetic outcome.

Tools and Equipment:

• Surgical scalpels and scissors
• Vascular clamps and sutures
• Magnifying loupes or surgical microscope
• Hemostatic devices and electrocautery

Anesthesia:

• General anesthesia is typically used.

Duration

The procedure usually takes 2 to 4 hours, depending on the complexity and extent of reconstruction needed.

Setting

The surgery is typically performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeons specialized in plastic and reconstructive surgery
• Nurses specializing in perioperative care
• Anesthesiologists
• Surgical assistants

Risks and Complications

Common Risks:

• Bleeding
• Infection
• Scarring

Rare Risks:

• Tissue necrosis due to inadequate blood supply
• Asymmetry or deformity
• Nerve damage
• Need for revision surgery

Benefits

• Restoration of facial structure and aesthetics
• Improved functional abilities, such as eating and speaking
• Enhanced self-esteem and quality of life

Recovery

• Postoperative care includes monitoring for signs of infection and ensuring proper blood flow to the flap.
• Pain management with prescribed medications.
• Keeping the head elevated to reduce swelling.
• Follow-up appointments to monitor healing and remove sutures.
• Avoiding strenuous activity for at least 4 to 6 weeks.

Alternatives

• Local flap procedures without vascularized pedicles
• Free tissue transfer (free flap) techniques
• Non-surgical options like prosthetics or fillers
• Each alternative comes with its own set of risks, benefits, and recovery times which should be discussed with the healthcare provider.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel pain. Postoperatively, patients may experience discomfort, swelling, and bruising in the facial area, which can be managed with pain medication and cold compresses. Complete healing and final results may take several weeks to months.