Repair methods of complex facial defect wounds involving paranasal sinuses and their clinical effectiveness

Liang Pengfei; Xu Xisheng; Zhang Pihong; Bi Changlong; Zhang Hua; Huang Mitao; He Zhiyou; Zeng Jizhang; Huang Yun; Li Jia; Cui Xu; Zhou Situo; Zhang Minghua; Huang Xiaoyuan

doi:10.3760/cma.j.cn501225-20221130-00520

Volume 39 Issue 3

Mar. 2023

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2023 > 39(3): 221-227

Liang PF,Xu XS,Zhang PH,et al.Repair methods of complex facial defect wounds involving paranasal sinuses and their clinical effectiveness[J].Chin J Burns Wounds,2023,39(3):221-227.DOI: 10.3760/cma.j.cn501225-20221130-00520.

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Repair methods of complex facial defect wounds involving paranasal sinuses and their clinical effectiveness

doi: 10.3760/cma.j.cn501225-20221130-00520

1.
Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
2.
Department of Burns and Plastic Surgery, Chenzhou First People's Hospital, Chenzhou 423099, China
3.
Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008, China
4.
Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha 410008, China

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General Program of National Natural Science Foundation of China 81974287

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Corresponding author: Xu Xisheng, Email: czyyxxs@126.com; Zhang Pihong, Email: zphong@aliyun.com
Received Date: 2022-11-30

Abstract

Abstract

Objective To explore the repair methods of complex facial defect wounds involving paranasal sinuses and their clinical effectiveness. Methods A retrospective observational study was conducted. From January 2020 to May 2022, 5 patients admitted to the Department of Burns and Plastic Surgery of Xiangya Hospital of Central South University and 4 patients admitted to the Department of Burns and Plastic Surgery of Chenzhou First People's Hospital with complex facial defect wounds involving paranasal sinuses met the inclusion criteria, including 6 males and 3 females, aged 35-69 years, including 4 patients with titanium mesh exposure combined with paranasal sinuses injury and 5 patients with tumor involving paranasal sinuses. After an adequate assessment of the damage by a multiple discipline team, titanium mesh removal, paranasal sinus debridement, and paranasal sinus mucosa removal were performed in patients with exposed titanium mesh, and radical tumor resection was performed in patients with tumors, with postoperative skin and soft tissue defects areas of 5.0 cm×2.5 cm to 18.0 cm×7.0 cm, anterior paranasal sinus wall defects/absence areas of 3 cm×2 cm to 6 cm×4 cm, and sinus cavity depths of 1 to 4 cm. Depending on the perforator course of the descending branch of the lateral circumflex femoral artery, the anterolateral femoral chimeric flap or anterolateral femoral myocutaneous flap (with flap area of 9 cm×4 cm to 19 cm×8 cm, muscle size of 5 cm×3 cm×3 cm to 11 cm×6 cm×3 cm) was transplanted to repair the defect, and the donor site wound was sutured directly. The type of tissue flap transplanted, the blood vessel of the recipient area, and the vascular anastomosis way during the operation, the recovery of the donor and recipient areas and the occurrence of complications after operation were observed. The appearance and blood supply of the recipient area and the recurrence of ulcers and tumors were followed up. Results The anterolateral femoral myocutaneous flap transplantation was performed in 6 patients, and the anterolateral femoral chimeric flap transplantation was performed in 3 patients. The blood vessels in recipient areas were facial arteries and veins in 3 cases and superficial temporal arteries and veins in 6 cases. The superficial temporal arteries and veins were bridged with blood vessels in tissue flaps by flow-through way in 2 patients, and end-to-end anastomosis of blood vessels in donor and recipient areas was performed in 7 patients. After operation, all the tissue flaps survived, and the facial defect wounds were well repaired without cerebrospinal fluid leakage or paranasal sinus secretion leakage, no intracranial infection occurred, and the wounds in donor areas were healed well. Follow-up of 6-35 months after operation showed that all the patients had good blood supply in the recipient area, and the shape was acceptable; 4 patients with exposed titanium mesh had no recurrence of ulceration, and 5 patients with tumor had no local tumor recurrence or metastasis. Conclusions Based on an adequate assessment of the extent of paranasal sinuses involved in the facial wound and the nature of the defect, good clinical effects can be achieved by using the anterolateral femoral muscle flap or the anterolateral femoral chimeric flap transplantation to repair complex facial defect wounds with open paranasal sinuses.
- Wounds and injuries,
- Neoplasms,
- Face,
- Paranasal sinuses,
- Microsurgery,
- Surgical flaps,
- Wound repair

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References

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Repair methods of complex facial defect wounds involving paranasal sinuses and their clinical effectiveness

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Repair methods of complex facial defect wounds involving paranasal sinuses and their clinical effectiveness

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