Facial Platysma Flap

Description -o

The facial platysma flap is a skin-muscle flap based on the pars modiolaris portion |

of the platysma (41). The pars modiolaris represents the muscle fibers that extend »

over the mandible to insert on the ipsilateral modiolus, and are located just lateral c to the lateral border of the depressor anguli oris muscle. Motor innervation is via the marginal branch of the facial nerve and sensory innervation is from the mental nerve (trigeminal). Vascular supply is via the facial artery as it crosses the mandible. |

The defect should be triangular or wedge-shaped and the flap is designed just lateral in the shape of an inverted 'V' with identical dimensions; its base is oriented along §

the border of the mandible. The platysmal fibers are incised, preserving the neurovascular structures to the flap. The flap is rotated toward the defect, leaving a raw inner surface that must be covered with a cheek mucosal flap. Flap rotation results in the reorientation of the platysmal fibers into a more horizontal position. A similar type of flap (the submental artery island flap) harvested from the submental area has been described (42).

Indications

This flap is indicated for lateral defects involving over one-third of the length of the lower lip, where the depressor anguli oris muscle is missing or of no use (Fig. 24). Bilateral flaps must be used for total lip reconstruction.

Advantages

The flap provides a functional reconstruction of the lower lip with local tissues. The color and texture match to the missing segment of lip is excellent.

Submental Myocutaneous Flap

Disadvantages

This is not a full-thickness flap and mucosal lining must be obtained from the adjacent cheek. The platysmal fibers under the flap may be difficult to identify in some patients due to excessive thinning of the muscle in the perioral area. The marginal branch of the facial nerve is at risk for injury because it must be dissected laterally to free the flap for sufficient rotation. Trap door scarring is common.

REFERENCES

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22. Donelan MB. Reconstruction of electrical burns of the oral commissure with a ventral tongue flap. Plast Reconstr Surg 1995; 95:1155-1164.

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39. Stranc MF, Robertson GA. Steeple flap reconstruction of the lower lip. Ann Plast Surg tao

40. Tobin GR, O'Daniel TG. Lip reconstruction with motor and sensory innervated ^ composite flaps. Clin Plast Surg 1990; 17:623-632. >3

41. Moschella F, Cordova A. Platysma muscle cutaneous flap for large defects of the lower ^ lip and mental region. Plast Reconstr Surg 1998; 101:1803-1809. q

42. Yilmaz M, Menderes A, Barutcu A. Submental artery island flap for reconstruction of |

the lower and mid face. Ann Plast Surg 1997; 39:30-35. S

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