A cadaver study in preparation for facial allograft transplantation in humans: part I. What are alternative sources for total facial defect coverage?

BACKGROUND

Reconstruction of facial defects in burn, trauma, and head-neck cancer patients is challenging. The lack of autogenous tissue availability and the need to match facial texture and color are major concerns.

METHODS

Anatomical dissections were performed to search for alternative sources for facial-scalp reconstructions in five cadavers. The composite facial-scalp flaps, radial forearm, anterolateral thigh, bipedicled deep inferior epigastric perforator, and bipedicled scapular-parascapular flaps were harvested. The total surface areas of the facial defects and alternative traditional flaps were measured.

RESULTS

The mean surface area for combined facial-scalp flaps and facial flaps without scalp was 1192 +/- 38.2 cm and 675 +/- 22.3 cm, respectively. When compared with the total surface area of the facial-scalp flap, it was found that the radial forearm flap covered 13 +/- 2.58 percent, the anterolateral thigh flap 19 +/- 3.72 percent, the bipedicled deep inferior epigastric perforator flap 35 +/- 1.56 percent, and the bipedicled scapular-parascapular flap 48 +/- 4.64 percent of the defect, respectively. When measurements were taken for coverage of the facial defect without scalp, it was found that the radial forearm flap covered 24 +/- 4.0 percent, the anterolateral thigh flap 34 +/- 6.50 percent, the bipedicled deep inferior epigastric perforator flap 62 +/- 3.03 percent, and the bipedicled scapular-parascapular flap 84 +/- 8.30 percent of the defect, respectively.

CONCLUSIONS

The authors' cadaver dissection confirmed that none of the conventional cutaneous autogenous flaps are able to cover total facial defects. Currently, the best option for reconstruction of the full facial defect is the autogenous bipedicled scapular-parascapular flap because of its large size and texture. However, perfect match of facial skin texture, pliability, and color can only be achieved by transplantation of the facial skin allograft from the human donor.