The Versatility of Preexpanded Occipitocervicopectoral Flap in Unilateral and Bilateral (COVID Flap) Facial Resurfacing After Burn Injuries

Abstract

Background: Postburn facial scars represent a major reconstructive challenge due to the functional and aesthetic importance of the face. The preexpanded occipitocervicopectoral (OCP) flap provides thin, color-matched tissue suitable for facial resurfacing. This study aimed to evaluate the versatility and outcomes of unilateral and bilateral preexpanded OCP flaps in postburn facial reconstruction.

Methods: A prospective study was conducted between May 2021 and May 2023, including 26 patients with postburn facial scars who underwent resurfacing using unilateral or bilateral preexpanded OCP flaps. Tissue expanders were placed beneath the planned flap and progressively inflated before the flap was transferred. A novel flap design, termed the "COVID" or "bat" flap, was developed and derived from bilateral expanded OCP flaps, enabling simultaneous bilateral facial reconstruction after division along the midline. Demographic, clinical, and surgical data were collected, and patient-reported outcomes were assessed using the FACE-Q questionnaire before and after surgery.

Results: Twenty-nine preexpanded OCP flaps were transferred in 26 patients (17 males, 9 females; mean age, 14 years). The mean expander volume was 393 mL, and the mean flap dimensions were 12 × 8 cm. No total flap loss occurred. Distal necrosis developed in 5 flaps (17%), all located at or above the zygomatic arch, and was managed successfully with conservative measures or skin grafting. FACE-Q analysis demonstrated significant postoperative improvement across all domains ( P < 0.001), except for "appraisal of neck." Subgroup analysis revealed no significant difference in FACE-Q improvement between patients with and without distal flap necrosis.

Conclusions: The preexpanded OCP flap provides a reliable and aesthetically favorable option for postburn facial resurfacing, offering color-matched, thin tissue coverage with minimal donor-site morbidity. The bilaterally preexpanded "COVID" modification further enhances its versatility for simultaneous reconstruction of both cheeks and the upper neck.

Keywords: COVID flap; FACE-Q; facial burn; occipitocervicopectoral flap; perforator flap; reconstructive surgery; tissue expansion.