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AAPS 85th Annual Meeting
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Expanded Transposition Flap Algorithm for Total and Subtotal Facial Reconstruction: A Seventeen Year Experience
Robert J. Spence, M.D..
Johns Hopkins School of Medicine, Baltimore, MD, USA.

PURPOSE: Reconstruction of major facial burn deformities is a continuing challenge for surgeons who wish to restore reliably facial function and appearance. The primary problem is deficiency of well-matched donor skin. The unique characteristics of facial skin, the fine anatomic nuances, and the unique functional demands placed on the face make it difficult to reconstruct. This study tests the validity of an algorithm developed using an expanded shoulder transposition flap for total and subtotal reconstruction of the face.
METHODS: An expanded shoulder transposition flap has been used since 1986 for head and neck resurfacing. An algorithm was developed for total and subtotal resurfacing of the face, the validity of which was tested.
RESULTS: This flap was used 52 times in 39 patients ranging in age from 2 to 62 years. The flap proved remarkably reliable and reproducible in resurfacing the peripheral facial aesthetic units. The pedicle skin is often used for grafting of the central face with its finer features. The donor site of the flap is closed primarily.
CONCLUSION: This study examines the experience with the expanded shoulder transposition flap and the algorithm that was developed using its components to provide versatility in facial reconstruction. The algorithm has proven to be valid, and the technique well within the skill, patience, and courage of most reconstructive surgeons.

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