Reconstruction of Large Facial Defects via Excision of Skin Cancer Using Two or More Regional Flaps

BACKGROUND: 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. METHODS: 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. RESULTS: Two and 3 types of flaps were used for 5 and 2 patients, respectively. Most frequently used were nasolabial flaps (7 times in 6 patients) and forehead flaps (once in each of 4 patients). The average follow-up period was 14 months, with no complications—including necrosis, hematoma, or wound dehiscence—observed. Post-surgical satisfaction averaged 4.4 out of a maximum of 5 points. CONCLUSIONS: Reconstruction using two or more flaps for large facial defects after skin cancer removal using MMS produced satisfactory outcomes while preventing aesthetic problems. Practitioners should consider using multiple flaps when choosing a reconstruction method for large facial defects following skin cancer removal.

Repair of two skin and soft tissue defect in hand by three types of multiple flaps from the foot / 中华显微外科杂志

Objective To explore the clinical outcomes of three types of multiple flaps from the foot for re-construction of two skin and soft tissue defects in hands. Methods From February, 2003 to September, 2015, 23 cases of hands with two skin and soft tissue defects were treated with 3 types of multiple flaps from the foot. Among of them, 10 cases of adjacent fingers were treated with double foliated pulp flaps from the big toe and the second toe based on a single vascular pedicle of the first dorsal metatarsal vessels; 2 cases of composite tissue defect including finger and hand were treated with double foliated pulp flaps from dorsalis pedis flap and the big toe based on a single vascular pedicle of the dorsalis pedis artery;11 cases of two composite tissue defect in hand were treated with dorsalis pedis flaps based on a single vascular pedicle of the dorsalis pedis artery. The donor site was covered with full-thick-ness skin. All patients were followed-up regularly which included three aspects:appearance, hand function and senso-ry recovery. Results Twenty-three cases of double foliated pulp flaps were survived. Postoperative follow-up time ranged from 3 to 36 months, with an average of 15 months. The postoperative follow-up revealed satisfactory shapes of the multiple flaps and recovery of functions. The sensation was recovered to S 2-S4. The grafting skin in donor site sur-vived completely excluding partial necrosis in 3 cases. The wound were treated by wound dressing, local scar hyper-plasia in donor sites. There was no apparent impairment on the foot function. Conclusion Three types of multiple flaps from the foot based on a single vascular pedicle for reconstruction of two skin and soft tissue defects in hand could achieve good clinical outcomes. The type of flaps can be adapted according to the injury.