1. Ka-Wai, Liu; Tsung-Chun, Huang; Hung-Chi, Chen
Case Report: Aesthetic Unit Reconstruction with Anterolateral Thigh Flap after Wide Excision of Facial Dermatomal Vascular Malformation and Hemangioma
Ka-Wai, Liu; Tsung-Chun, Huang; Hung-Chi, Chen
Department of Plastic and Reconstructive Surgery,
China Medical University Hospital,
China Medical University,
Taichung, Taiwan

2. Disclosure
Nothing to disclose

3. Combined hemangioma and vascular malformation

4. Hemangioma and Vascular malformation
Maxillary branch of trigeminal nerve (V2)
oral mucosa/cheek/nasal side wall/right lateral philtrum/Right medial canthus/right upper eyelid
Size of lesion: 9x 9 centimeters

5. Magnetic resonance imaging
Right cheek vascular malformation
Cutaneous to deep soft tissue and masseter muscle

6. Surgical method Aesthetic unit : One staged ALT flap reconstruction
excision and reconstruction
Preservation
Right great auricular nerve
Right facial nerve trunk and its branches
Parotid gland
One staged ALT flap reconstruction
Donor site:
partially closed/split thickness skin graft coverage.

7. 17 months after operation

8. Pathological findings
Vascular
Malformation
(H&E: 40x)
Involved margin
of hemangioma
(H&E:100x)

9. Discussion

10. The role of surgical treatments
Satisfaction rate: 45~55%, (N=203)
laser for dermatomal port-wine stains
Poor prognostic factor
Capillary malformation :
second branch of trigeminal nerve (V2) distribution
When port wine stain has become long-standing lesion, wide excision and one stage reconstruction will be the appropriate option
Plastic and reconstructive surgery, (4): p

11. Surgical consideration
Untreated superficial nodular hemangioma with epidermal invasion
75 % persistent deformity, especially in prior bleeding, ulcer, and infection
Matured port-wine stain
thickening and cobblestone ectasia
turned into fast-flow malformation
Plastic and reconstructive surgery, (4): p
Plastic and reconstructive surgery, (2): p

12. Reconstructive methods
Full thickness skin graft (FTSG)
limited size of the donor site
Thick split thickness skin graft (STSG)
Thick STSG: donor site severe hypertrophic scar
Facial expression muscles involvement
skin graft will not provide enough soft tissue for volume expansion.
Archives of plastic surgery, (2): p

13. Reconstructive methods
Free flap : extended lesions
Free radial forearm flap
Free anterolateral flap
Pre-expanded ultra-thin supraclavicular flap
Cervicothoracic skin flap prefabricated by lateral thigh flap
Prefabricated induced expanded supraclavicular skin flap

14. Limitation of this case
Slight ectropion
lateral part of right lower eyelid
Right medial canthus contracture
Right lip downward displacement
Drooping and bulky flap
Color of skin: need tattooing

15. Conclusion
Surgical resection is one of the options to treat facial dermatomal capillary malformation with minimal complications based on aesthetic unit reconstruction.
Acceptable contour can be achieved by anterolateral thigh flap with minimal donor site morbidity.