Reconstructing the Holey Temple: A Composite Approach.

Emma Russell,Aton Holzer,Thomas Knackstedt,Jeremy Udkoff

doi:10.7759/cureus.22621

Abstract

Surgical defects involving multiple facial cosmetic subunits can be challenging to reconstruct. We report on a patient with a complex temporal defect following Mohs micrographic surgery (MMS) for a basal cell carcinoma (BCC). The extension of the defect across the left temple, cheek, and forehead hindered the utilization of linear closures or flaps. Healing by secondary intention was considered but was determined to be a suboptimal approach given the involvement of the convex cheek. A modified full-thickness skin graft (FTSG) with linear closures of the distal poles of the wound was ultimately utilized, with excellent cosmetic results at three-month follow-up. Herein, the authors summarize this case and the indications for FTSG and secondary intention healing (SIH) for surgical defects involving the face.

Highlights

Surgical defects spanning multiple cosmetic subunits can be challenging to reconstruct and may require multiple repair techniques to achieve a good cosmetic result
fullthickness skin grafts (FTSG) can be useful in areas where linear closures or flaps may cause significant distortion, such as the periorbital area, ear, and nose [3]
We present a case of a reconstruction using modified FTSG and linear closures in a patient with a complex temporal defect following Mohs micrographic surgery (MMS)

Summary

Introduction

Surgical defects spanning multiple cosmetic subunits can be challenging to reconstruct and may require multiple repair techniques to achieve a good cosmetic result. Secondary intention healing (SIH) or fullthickness skin grafts (FTSG) may be considered for complex defects not amenable to linear closures. Undermining was performed out to one-half the width of the wound on the two distal ends These areas were approximated with linear closures. A recipient template was created by placing 4 x 4 gauze on the remaining defect This was used to harvest a slightly larger modified FTSG (to accommodate for contraction) from post-auricular skin on the patient’s left side. This donor site was chosen primarily due to its proximity and close match to the color, texture, and thickness of the recipient site. The edges of the graft site were approximated with a linear closure in the usual fashion.

Discussion

Conclusions

Findings

Disclosures

Zitelli JA