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PURPOSE: To explore versatile techniques to repair the cheek skin defects according to the different anatomical units with tissue expansion and find reasonable and effective design and transposition principles to transfer the expanded flaps according to the different characteristics of defects.
METHODS: A total of 308 patients underwent cheek skin defects restoration by tissue expansion technique. According to the locations and the shapes of cheek skin defects, the cheek area was divided into three subunits and some principles to design and transpose the expanded skin flaps were investigated. The flexible composite transferring patterns of the expanded skin flaps were summarized and classified.
RESULTS: All reconstructions were completed satisfactorily. In all 308 cheek defects, there were 547 expanded skin flaps in this series, which included 219 the rotation skin flaps (40%), 71advanced skin flaps (13%), and 257 transposition skin flaps including the composite transferring patterns (47%). The complication occurred in 104 expanded flaps (19%). 35 expanded flaps appeared blood embarrassment, in which, 28 rotation-advanced skin flaps and 7 transposition skin flaps. Less than one third of the compromising part became necrotic.117 cases were followed up, ranging from 2-45 months. The revisions of the widened scars, the dog-ears and the contracted strips were recommended 6 months after operation.
CONCLUSIONS: Our clinical satisfactory results proved that tissue expanded flaps achieved not only functional reconstruction but also aesthetic outcome. Tissue expansion technique is still a very safe and effective option for the reconstruction of many cheek defects. Those principles to design and transfer the expanded skin flaps were safe, available, flexible and reproducible in treatment of cheek skin defects, which could also be used to treat the skin defects of the other parts of body.