An algorithm for total and subtotal facial reconstruction using an expanded transposition flap: a 20-year experience.

Background: Reconstruction of major facial soft-tissue deformities and deficits is a continuing challenge for surgeons who wish to reliably restore facial function and appearance. A primary problem is deficiency of well-matched donor skin. Others include the unique characteristics of facial skin, the fine anatomical nuances, and the unique functional demands placed on the face making reconstruction difficult. The author presents an algorithm developed for total and subtotal reconstruction of the face using an expanded shoulder transposition flap as a key element. Methods: Expanded shoulder transposition flaps have been used since 1986 for head and neck resurfacing. An algorithm using the expanded shoulder transposition flap as a key element was developed for total and subtotal resurfacing of the face. The validity of this approach was evaluated by clinical results over 20 years. During that time, expanded shoulder transposition flaps were used 58 times in 41 patients ranging in age from 2 to 62 years. Results: With the expanded shoulder transposition flap as its central component, the algorithm proved remarkably reliable and reproducible in resurfacing the peripheral facial aesthetic units with the main flap, and the pedicle skin often used for grafting the central face with its finer features. The donor site of the flap is closed primarily. Conclusions: This study examines the experience using an algorithm developed with the expanded shoulder transposition flap for major facial reconstruction. The experience suggests that the algorithm provides versatility and reliability; minimizes the donor-site defect; and is well within the skill, patience, and courage of most reconstructive surgeons.