title: Cervicofacial advancement-rotation flap in midface reconstruction: forward or reverse?
abstract: OBJECTIVE
  To present the authors' experience and outcomes in the reconstruction of midfacial defects using cervicofacial advancement-rotation flaps (CARFs) based on a method of determining forward or reverse design in relation to the proportions of the defect.
  
  
  METHODS
  Case series with retrospective chart review.
  
  
  METHODS
  Tertiary care academic medical center.
  
  
  METHODS
  Patients who underwent CARF reconstruction and the subset of patients with midfacial defects medial to the lateral canthus were included. CARF was designed in a forward fashion with an anteromedial movement for the defects with a larger vertical dimension and in a reverse fashion with a posterosuperior movement for the defects with a larger horizontal dimension.
  
  
  RESULTS
  Thirteen of 45 patients who underwent CARF reconstruction qualified for the analysis as a subset based on defect location. CARF was used in a forward fashion in 7 patients and in a reverse fashion in 6 patients. The largest defect in this subset was measured as 9 × 6 cm, while the smallest defect was 3 × 2 cm. Average follow-up was 11.5 months. None of the patients developed partial or total flap loss. Six patients had mild ectropion, which was managed with conservative measures only. The outcome of the reconstruction was satisfactory in all cases.
  
  
  CONCLUSIONS
  Designing the CARF based on the proportion of the vertical and horizontal diameters of the selected midfacial defects as described allows for closure of the defects with minimal tension and minimizes the amount of discarded healthy skin overlapping at the suture lines.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
authors.forename: Jennings R
authors.initials: JR
authors.lastname: Boyette
authors.forename: Emre
authors.initials: E
authors.lastname: Vural
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005145:Face / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009333:Neck / Q000601:surgery*; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000379:methods*; D012399:Rotation; D013524:Surgical Flaps; D016896:Treatment Outcome