Application of the Filatov tube flap
The Filatov tubed pedicle flap is used for extensive non-full-thickness defects of the periororal region when the patient's local tissues are insufficient for primary wound closure.
Formation and transplantation:
- A skin-fat strip is harvested from the donor site, rolled into a tube, and sutured. If there is high tension, relieving incisions are used.
- After 16–21 days, the flap is transplanted. The recipient bed is prepared with a semilunar incision.
- Insetting is performed using the "plug" principle: adipose tissue is left at the end of the pedicle to firmly wedge into the recipient bed. This minimizes hematomas and stimulates neoangiogenesis.
- As a final step, the tube flap is flattened to replace the required area.
The main disadvantage of this technique is the extreme duration of treatment and the risk of necrosis due to compromised blood supply. Additionally, a lip created from such a flap is completely immobile.
Restoration of the upper lip with local tissues
Local musculocutaneous flaps match the color well and retain contractility because they contain fibers of the buccinator muscle or the quadratus labii superioris muscle. The blood supply to these tissues comes from the angular artery (a. angularis).
To eliminate full-thickness defects of the upper lip, classic techniques are used:
- Bruns method — transposition of triangular flaps designed along the nasolabial folds.
- Shimanovsky method — advancement of horizontal flaps from the cheeks toward the midline.
- Sedillot method — creation of full-thickness rectangular flaps from the lower lip area and their upward advancement.
A significant disadvantage of local flap plastic surgery is the risk of severe narrowing of the oral aperture (microstomia), which often requires additional corrective procedures.
Dynamic correction of transplanted flaps
Since a lip reconstructed solely from a round tube flap sags and does not retain saliva, surgeons must combine techniques to restore its muscle tone. This is especially relevant for the lower jaw.
- M.V. Mukhin's method: A tunnel is created in the reconstructed lower lip. A fragment of the fascia lata (fascia lata) is placed into it, and its ends are sutured to the tendinous parts of the masticatory muscles (m. masseter). The contraction of the masticatory muscles is transmitted to the lip.
- N.M. Mikhelson's method: The lower half of a split orbicularis oris muscle (m. orbicularis oris), harvested from the healthy upper lip, is implanted into the fat base of the transplanted flap.
Deformities of the oral aperture and chin
Microstomia (narrowing of the mouth) is corrected surgically 6–8 months after scar maturation. The normal adult mouth width is 6–7 cm. The most critical rule of the operation: tissues are incised with mandatory overcorrection, as maturing scars will inevitably pull the mouth corners back.
In case of a wide oral aperture (macrostomia), excess tissue is excised and the wound is closed to the anatomical norm. If the corners of the mouth are displaced, transposition flaps (z-plasty) are used.
Chin defects are extremely rare in isolation. They lead to constant mouth gaping, severe drooling, and even breathing problems (in case of bone detachment and tongue drop back). If the mandible is preserved, soft tissues are restored by advancing a single cervicofacial musculocutaneous block along with the platysma (e.g., using the Dieffenbach method).
Briefly: answers to topical questions
What is the anatomical structure and blood supply of local musculocutaneous flaps of the upper lip?
The anatomical structure of local musculocutaneous flaps for upper lip reconstruction necessarily includes muscle fibers, and their blood supply is provided by the angular artery.
Mandatory composition of the flap:
- Quadratus labii superioris muscle — muscle fibers are included to replace the defect.
- Buccinator muscle — an alternative source of muscle fibers.
Blood supply:
- Angular artery (a. angularis) — supplies blood to the flap tissues.
To memorize the classic techniques of local lip plastic surgery, use the acronym BShS: Bruns (follows the folds), Shimanovsky (steps from the cheeks), Sedillot (shifts from below).
Class and exam questions
Why is the "plug" technique used in Filatov tubed pedicle plasty?
Implanting the end of the pedicle with preserved adipose tissue into the recipient bed securely closes the cavity. This reduces the risk of blood accumulation (hematoma) and accelerates neoangiogenesis.
In what sequence are the lips reconstructed when they are simultaneously destroyed?
Reconstruction always begins with the lower lip. This is a primary measure necessary to eliminate constant drooling, which severely impacts the patient's mental state and causes maceration of the neck skin.
Why is overcorrection necessary when treating microstomia?
Following the surgical widening of the oral aperture, the wound scarring process begins. If a 1 cm margin is not incorporated on each side, the maturing scars will critically narrow the mouth tissues again.
What else to study on this topic
- Stages of formation and insetting of the Filatov tube flap
- Specific complications of pedicle flap surgery
- Methods for reconstructing the vermilion border of the lips
- Surgical treatment of congenital double lip
- Rauer method for forming the corners of the mouth
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Other topics in «Chapter 15. Reconstructive surgery of the face and jaws (V.N. Bogatov, S.N. Lebedev)»
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