Abstract
Rationale: In the last decade, the incidence of skin cancers has been increasing. Early diagnosis, treatment and prevention are crucial in helping to diminish the incidence, mortality and morbidity associated with skin cancers.Objective: This article presents arguments for and against local anesthesia in the treatment of skin cancers, including the clinical cases, a summary of treatment, and prognosis.Methods and results: Under local anesthesia, local and loco-regional flaps offer an optimal shape and volume for face reconstruction, minimizing the operative time and therefore the hospitalization. Facial skin cancer surgery under local anesthesia also contributes significantly to decreasing health care costs compared to general anesthesia.Discussions: Although in our practice, excision of skin tumors in the facial area under local anesthesia is a frequent and harmless surgical method, it can cause increased stress in some patients. However, the benefits are significantly greater than the disadvantages.
Highlights
Facial reconstruction after skin cancer removal is challenging and has multiple implications because, beyond the achievement of functional restoration, the surgeon must strive to provide an aesthetic outcome [1, 2].In this regard, knowledge of tissue biomechanics is imperative for proper wound closure [3]
Rotation flaps are frequently used when tensions from a potential primary closure would be too high. We mostly chose this type of flap in case of large defects, as tissue laxity allows rotation into the recipient site
The outcome was aesthetic in all cases
Summary
Facial reconstruction after skin cancer removal is challenging and has multiple implications because, beyond the achievement of functional restoration, the surgeon must strive to provide an aesthetic outcome [1, 2]. In this regard, knowledge of tissue biomechanics is imperative for proper wound closure [3]. The main principles aimed at providing optimal closure are: (1) skin closure under minimal tension, (2) replacing “like with like”, (3) preserving major anatomical structures (e.g., lip, nose, eyebrow), and (4) scar location corresponding to functional and aesthetic units of the face [8]. Apart from the above-mentioned, the success rate of surgery depends on a number of biological factors, independent of the surgeon’s abilities, such as: age, general health, medication, smoking habits, and other variables, such as: different skin characteristics (e.g., elasticity, actinic skin, sebaceous damage, skin thickness), previous scars, individual cicatrization capacity and so forth [5,6,7].
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