FACIAL RECONSTRUCTION WITH PREFABRICATED INDUCED EXPANDED (PIE) SUPRACLAVICULAR SKIN FLAPS

The prefabricated induced expanded (PIE) supraclavicular flap refers t o the staged transfer of an expanded supraclavicular skin with a fasci a flap used as the carrier. In three patients, we utilized PIE supracl avicular flaps to successfully reconstruct a total forehead and mio ma jor 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 usi ng simple pedicled flap transfers in either or both stages. Whenever f easible, the preferred method consists of transferring a temporopariet al fascia flap to a subcutaneous pocket in the ipsilateral supraclavic ular fossa and simultaneously placing a skin expander under both the f ascia flap and the supraclavicular skin. After adequate expansion, the fascia becomes incorporated within the capsule of the expander, and t he composite capsulofasciocutaneous flap can be safely transferred to the facial defect as the PIE flap.These patients show that supraclavic ular PIE flaps can provide ample amounts of vascularized cutaneous tis sue for the reconstruction of major facial defects. The necessary tiss ue 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 fl ap transfers, PIE flaps allow the transfer of expanded skin to distant sites as island or free flaps perfused by the induced vascular pedicl es.