Facial reconstruction with prefabricated induced expanded (PIE) supraclavicular skin flaps

Abstract

The prefabricated induced expanded (PIE) supraclavicular flap refers to the staged transfer of an expanded supraclavicular skin with a fascia flap used as the carrier. In three patients, we utilized PIE supraclavicular flaps to successfully reconstruct a total forehead and two major nasal defects. Our first PIE flap confirmed the feasibility of the method but necessitated two microvascular free flaps. In the ensuing two patients, we reduced the need for microvascular anastomoses by using simple pedicled flap transfers in either or both stages. Whenever feasible, the preferred method consists of transferring a temporoparietal fascia flap to a subcutaneous pocket in the ipsilateral supraclavicular fossa and simultaneously placing a skin expander under both the fascia flap and the supraclavicular skin. After adequate expansion, the fascia becomes incorporated within the capsule of the expander, and the composite capsulofasciocutaneous flap can be safely transferred to the facial defect as the PIE flap. These patients show that supraclavicular PIE flaps can provide ample amounts of vascularized cutaneous tissue for the reconstruction of major facial defects. The necessary tissue is generated by expanding the most desirable tissue type available, and a selected vascular pedicle is induced to perfuse and carry that generated tissue. Compared with conventional expansion and adjacent flap transfers, PIE flaps allow the transfer of expanded skin to distant sites as island or free flaps perfused by the induced vascular pedicles.