Cervicofacial flap

The cheek may be divided into zones for the purpose of classification. Zone 1 includes the suborbital and malar regions. Zone 2 comprises the temporal and preauricular areas. Zone 3 is composed of the perioral and mandibular regions. Defects of the cheek are most likely seen following tumor excision, but may also result from trauma. The cervicofacial flap has been described for the reconstruction of larger (>4 cm), full-thickness defects of the cheek. Smaller defects of the cheek may be closed by elevation and advancement of the circumferential skin. The cervicofacial flap is a large, widely undermined flap that is able to rotate to fill the indicated defect yet not leave a sizable donor defect. The cervicofacial flap is supplied by a random pattern of subcutaneous vessels. Multiple perforators to the skin arise from the deep facial artery, transverse facial artery, and superficial temporal artery, many of which are divided as the dissection proceeds in the subcutaneous layer. A deep plane cervicofacial flap variation carries the dissection below the level of the SMAS in the face and platysma in the neck. With this type of modification, the flap is a myofasciocutaneous flap with an axial blood supply but carries a higher risk for nerve injury. The design can also be extended into the upper chest if more coverage is needed. A canthopexy can be added to minimize the risk of lower eyelid malposition with healing. The cervicofacial flap is based on and is generally performed as a one-stage reconstruction that may or may not require later refinement.