Pedicled Skin Flaps of the Face: What to Keep in Mind
Luca Grimaldi2019, Journal of Investigative Surgery
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Abstract
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The paper discusses the use of pedicled skin flaps in facial reconstruction following the excision of skin tumors, particularly in the alar region of the nose. It highlights the advantages of local flaps over skin grafts concerning aesthetic outcomes, healing characteristics, and tissue integration. Key considerations include ensuring radical excision, aesthetic contiguity, and the limitations of reconstructive options based on the nature of the tumor and the surgical technique employed.
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Survival and aesthetic outcome of local flaps used for reconstruction of face defects after excision of skin malignancies: Multi-institutional experience of 175 cases
Background: Local facial flaps are frequently used reconstructive option and are carrying very good outcome as regard matching, texture, and less scarring. This study was designed retrospectively to evaluate the flap survival and aesthetic outcome of the three commonly used local facial flaps. Material and methods: Retrospective analysis of 175 patients whom were managed by local fasciocutanous flap reconstruction using advancement flap, nasolabial flap, and forehead flap. Results: Total flap survivals. Of 80 patients of advancement flaps 8 showed flap edge dehiscence, but all healed conservatively. Of 10 flaps underwent transposition local flaps in the nose, no any flap shows dehiscence. Of 52 nasolabial flaps, 2 showed dehiscence and of 33 forehead flaps, one showed dehiscence. All flaps were survived without any complications and V-Y advancement flaps were carried out the best aesthetic outcome. Conclusion: Local face flaps for reconstruction of post malignancy facial defects are carrying a sensational survival, however advancement flap carries the best aesthetic outcome.
Reconstruction of Large Facial Defects via Excision of Skin Cancer Using Two or More Regional Flaps
Archives of plastic surgery, 2017
Free-flap surgery and skin grafting can be used to reconstruct large facial defects that may result after skin cancer removal by Mohs micrographic surgery (MMS). However, these two methods may produce low postsurgical patient satisfaction with aesthetics, and free-flap surgery may produce an undue burden for the majority of skin cancer patients, who are of advanced age. Hence, the authors examined outcomes of large facial defect reconstruction using multiple flaps. Among patients undergoing MMS for skin cancer at Pusan National University Hospital between January 2013 and December 2015, we evaluated 7 patients (2 males, 5 females; average age, 73.14 years) treated for large facial defects from basal cell carcinoma. Based on operative and follow-up records, we investigated the number and type of flaps used, postsurgical complications, and patients' post-surgical satisfaction. Two and 3 types of flaps were used for 5 and 2 patients, respectively. Most frequently used were nasolabi...
Facial reconstruction after resection for cutaneous malignancies
Operative Techniques in Otolaryngology-Head and Neck Surgery, 2013
The reconstruction of facial defects after the resection of cutaneous malignant lesions is challenging. Knowledge of several key principles, such as that of facial subunits and of the reconstructive ladder, is paramount to achieving functionally and aesthetically pleasing surgical outcomes. Various reconstructive modalities, from local flap closure to free tissue transfer, are available to the practicing surgeon depending on the defect requiring reconstruction. In this article we describe several of the most commonly used local and regional flaps in facial reconstruction as well as some of the special challenges faced when reconstructing areas such as the eyelid, the lips, the nose, and the ear.
Original Study Antero-Lateral Thigh Flap in Reconstruction of Complex Facial Defects Resulted After Tumor Resections
2013
Reconstruction of large and complex defects of the face due to tumor resection is challenging for plastic surgeons. Free flaps allow one-stage reconstruction for cancer defects, and this is the main reason that the most complicated technique has become very used in head and neck surgery. In the last few years, antero-lateral thigh flap has become an important flap for face reconstruction, despite the difficulty of its dissection. 4 patients with cancer of the face have been operated on with this technique. The patients ages range from 54 to 59 years and all were men. After tumor ablation and neck dissection made by a maxillo-facial surgeon, the antero-lateral thigh flap has been raised by plastic surgeons and transferred into the defects, where the microvascular anastomoses has been done. The donor site has closed primarily. All 4 free flaps had survived without major complications. No patient required surgical revision. The follow-up period was 3 years – 3 months. No recurrence was...
Skin and composite grafts
Plastic and Aesthetic Research, 2022
Skin grafts may be used for coverage of facial defects in situations in which alternative methods of reconstruction, such as local flaps, are not an option. They may also be beneficial for patients who wish to avoid or who are not good candidates for more complex reconstruction. Full-thickness skin grafts often have a better color and texture match to adjacent skin when compared to split-thickness grafts; however, split-thickness grafts have lower metabolic demand and increased survival rate. Composite grafts may be very useful in the repair of defects with unique contour and support requirements, such as the nasal ala and eyelid. With all grafts, thoughtful planning and sound surgical technique are critical in achieving the best possible functional and aesthetic result.
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Dermatologic Surgery, 2006
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A conceptual framework for navigating the superficial territories of the face: Relevant anatomic points for the dermatologic surgeon
Clinical Anatomy, 2015
Recent publications in the dermatologic surgery literature have sparked a reemergence of interest in anatomy relevant for the Mohs surgeon necessitating a re-visit of under-appreciated concepts, regarding the topography of the face and its visceral contents from a surgically relevant perspective. This paper presents a pre-operative review and a conceptual framework for intraoperative planning for Mohs micrographic surgery and reconstruction. The key concepts presented are based on a series of (1) reviews regarding clinically significant points aimed at improving outcomes for reconstructive surgery, (2) anatomical dissections of fresh frozen cadavers, and (3) surgical experience of the authors. Basic anatomical concepts have been assimilated, surgically evaluated and re-directed toward the dermatologic surgeon in the hope that improved anatomic competence will reduce surgical hesitance.
Staged Cheek-to-Nose and Auricular Interpolation Flaps
Dermatologic Surgery, 2006
BACKGROUND. Staged interpolation flaps are priceless options in skin cancer reconstruction. Their value lies in their flexibility, reach, reliability, and ability to repair distant, complex facial defects. Familiar interpolation flaps to dermatologic surgeons include the paramedian forehead flap, cheek-to-nose interpolation flaps, and auricular staged flaps. OBJECTIVE. In this special reconstructive issue, the paramedian forehead flap is discussed separately. This article highlights the cheek-to-nose and auricular interpolation flaps as applied to skin cancer defects. Design considerations, anatomic basis, execution, and the distinctions of each repair are presented. MATERIALS AND METHODS. Patients with facial defects from Mohs micrographic surgery serve to illustrate the surgical techniques of each repair. RESULTS. With meticulous planning and thoughtful execution, cheek-to-nose and auricular staged flaps are capable of restoring both function and cosmesis. Several surgical stages are necessary, and an adequate supporting infrastructure is essential for an optimal outcome. CONCLUSION. Skin cancer patients with complex facial wounds from Mohs micrographic surgery may be assured of the highest possible cure rate. Further, their esthetic and functional reconstructive goals may be achieved with staged flaps for the nose and ear.
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Overview of local flaps of the face for reconstruction of cutaneous malignancies: Single institutional experience of seventy cases
Journal of Cutaneous and Aesthetic Surgery, 2016
The most common malignant tumours of the face are basal cell carcinoma, squamous cell carcinoma and melanoma. While the results of skin graft are less than satisfactory for large areas to cover, distant flaps are bulky with a poor colour match. Local fasciocutaneous flaps provide reasonable option for reconstruction of facial defects with good colour and texture match and good success rate. Aims: This study aimed to analyse the various modalities of reconstruction after resection of facial malignancies and their advantages and disadvantages. Settings and Design: This was a retrospective study. Materials and Methods: Of 70 patients, 34 were managed with V-Y advancement flap, 24 with nasolabial flap, 8 with median forehead flap and 4 with standard forehead flap cover. The duration of follow-up ranged from 6 months to 2 years. Statistical Analysis Used: Nil. Results: Of 34 V-Y advancement flaps, 2 showed suture dehiscence at the apex of triangle which was allowed to heal secondarily with regular dressings. All the 24 nasolabial flaps were healthy without any complication. All patients had satisfactory functional and cosmetic outcomes. Conclusions: In our experience, local flaps give the best results and are the first choice for reconstruction of the face. Most defects can be best closed by nasolabial, V-Y advancement and forehead flap. Outstanding functional and cosmetic results can be achieved. Proper execution requires considerable technical skill and experience.
Local Flaps in Facial Reconstruction
Journal of Oral and Maxillofacial Surgery, 2005
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Facial skin cancer reconstructive and cosmetic outcomes: Analysis with algorithm for its management
Background: Management of facial skin cancer and its complications is important research topics needing continuous update to improve the outcome.
A retrospective study to analyze local flaps for coverage of facial defects
International Surgery Journal, 2020
Background: Face is the center of attention during communication and the expression of emotion. Facial defects resulting from trauma and the excision of skin malignancies are relatively common. How this defect is treated is determined by a variety of factors including the location, size and the underlying cause of the defect, the projected functional morbidity, the medical history of the patient, and feasibility of surgery. Aim was to study various local flaps using for coverage of defect, outcomes and complications.Methods: This was a retrospective cohort study. Our study shows result of 92 patients during January 2016 to December 2019 who had facial defects were taken up for the study. Reconstructive options were selected depending on defect size, location. Follow-up of patients ranged from 6 months to 1 year.Results: The most common malignant tumors of the face are basal cell carcinoma, squamous cell carcinoma and melanoma. Local flap is always preferable than skin grafts as it p...
Baker shan r ed local flaps in facial reconstruction
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
Utility of a New Artificial Dermis as a Successful Tool in Face and Scalp Reconstruction for Skin Cancer: Analysis of the Efficacy, Safety, and Aesthetic Outcomes
Dermatology Research and Practice
Radical ablative surgery is the gold standard treatment of head skin cancer. The authors expose their experience with a new artificial dermis (Pelnac®), analyzing retrospectively the overall morbidity and aesthetic outcomes. 16 consecutive patients underwent two surgical procedures under local anesthesia. The first involved the tumor removal and application of the ADM. In the second, the exposed tissue was covered with a split-thickness skin graft. On follow-up (6 months), tumor recurrences, quality of scars (using the Vancouver Scar Scale), and patient reported outcomes (using FACE-Q Skin Cancer Module) were evaluated. 10 were males and 6 females, with a mean age of 73 years (61–89). The follow-up ranged from 12 to 48 months (mean: 30). The sites of skin tumor were scalp (12 cases), forehead (2), cheek (1), and zygomatic area (1). Nine patients underwent previous local surgery; two received radiotherapy. The average length of hospital stay was 3.2 days. The mean surface area of the...
Reconstruction of Complex Facial Defects After Radical Resection of Advanced Skin Cancers
Clinics in Plastic Surgery, 2005
Forehead Flap a Workhorse Flap for Facial Reconstruction-Our Experience at Tertiary Care Institute
Background: Managing post-traumatic or post-oncosurgical facial defects presents challenges. Minor defects may be treated with skin grafts or small local flaps, while larger ones necessitate advanced techniques like tissue expanders, prefabricated flaps, or free flaps. The enduring utilization of the forehead flap over centuries underscores its reliability in reconstructing substantial and intricate facial defects. Aim: Assess the viability and adaptability of forehead flap for facial reconstruction. Materials and Methods: 20 patients who underwent coverage of facial defects after trauma or tumor excision using forehead flaps were retrospectively analysed. The patient satisfaction and flap-related complications were analyzed. Results: 20 patients (18 males and two females) underwent reconstruction of different facial defects using 20 forehead flaps. The complication occurred in one patient only. The remaining 19 patients showed no complications and passed an uneventful follow-up period. All the patients were fully satisfied. Conclusion: The forehead flap effectively addresses facial defects, likely offering optimal results with its excellent skin match in color, texture, and thickness. Despite the rising popularity of free flaps, the forehead flap remains a valid and secure choice, ensuring both aesthetic and functional success in covering facial defects.
Risk Stratification of Local Flaps and Skin Grafting in Skin Cancer-Related Facial Reconstruction: A Retrospective Single-Center Study of 607 Patients
Journal of Personalized Medicine
Background: Non-melanoma skin cancer (NMSC) takes up a substantial fraction of dermatological and plastic surgical outpatient visits and surgeries. NMSC develops as an accumulated exposure to UV light with the face most frequently diagnosed. Method: This retrospective study investigated the risk of complications in relation to full-thickness skin grafts (FTSG) or local flaps in 607 patients who underwent facial surgery and reconstruction at a high-volume center for facial cancer surgery at a tertiary university hospital. Results: Between 01.12.2017 and 30.11.2020, 304 patients received reconstructive flap surgery and 303 received FTSG following skin cancer removal in the face. Flap reconstruction was predominantly performed in the nasal region (78%, n = 237), whereas FTSG reconstruction was performed in the nasal (41,6%, n = 126), frontal (19.8%, n = 60), and temporal areas (19.8%, n = 60), respectively. Patients undergoing FTSGs had a significantly higher risk of hematoma (p = 0.00...
Superficial skin texture: a study on full-thickness skin grafting in facial reconstruction
European Journal of Plastic Surgery, 2002
Usually in harvesting a full-thickness skin graft, we match color, skin thickness, and the presence of hair in the potential donor site with the recipient site to obtain as good an esthetic result as possible. Superficial skin texture is, in part, responsible for the esthetic result in facial reconstruction. Full-thickness skin grafts harvested from the supraclavicular region in 20 patients operated on for facial skin tumors and immediate reconstruction, were included in this study. The superficial skin texture was reproduced using a silicone cast technique; a polyvinylsiloxane derivative was used and it was analyzed by scanning electron microscopy (SEM) in order to detect and measure morphological features of the skin surface. The mechanism affecting superficial skin texture was studied to elucidate the importance of the superficial skin texture of the graft donor site and consequently the intraoperative orientation of the graft into the recipient area to improve the esthetic outcome. Our study shows that the forces of the recipient site are able to modify full-thickness skin graft dermis and as a result change the overlying superficial skin pattern. The graft always tends to change to the features of the recipient area after 24 months because of the environment of the new site. These findings suggest that color and thickness of the donor site still remain more important than intraoperative graft orientation in the recipient area in order to achieve good esthetic results in skin grafting.
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