Cheek Skin Defects Research Articles

Supraclavicular Artery Island Flap in Head-and-neck Reconstruction: Our Experience

Background: Reconstruction of head-and-neck cancer defects is a challenging task, keeping in mind the complexity of the defects. Locoregional pedicle flap reconstruction is not an inferior option. The supraclavicular flap gained popularity in 1997 to reconstruct mentosternal contractures in postburn patients. This is a perforator-based pedicled, axial, and fasciocutaneous flap based on the supraclavicular artery. This study aims to examine a series of cases with pedicled supraclavicular flap reconstruction in head-and-neck cancers. Methods: This study is a retrospective review of patient data from our institution from 2018 to 2020. A total of seven patients were included who underwent surgical resection for various head-and-neck cancers. Surgical defects were reconstructed with a supraclavicular islanded fasciocutaneous flap. Results: All patients underwent wide excision of the tumor following oncological principles, and four out of seven patients received postoperative adjuvant radiotherapy. Two patients with parotid tumors underwent facial skin excision along with total parotidectomy. Both cases were recurrent. One patient had partial necrosis of the distal part of the flap. Two patients required split-thickness skin graft for the closure of the donor site. Conclusion: Supraclavicular artery island flap (SCAIF) is one of the good reconstructive options for midline neck defects, simple oral cavity defects, and cheek skin defects. It is an excellent alternative to free tissue transfer with limited donor-site morbidity. Careful selection of patients is key to successful reconstruction using a SCAIF in the head-and-neck region.

Treatment of donor site wounds using facial skin remaining in the scar area.

Reconstruction of cheek skin defects is surgically challenging. We evaluated the outcomes of using cheek skin remaining in the scar area for treating donor site wounds following the repair of cheek skin defects using full-thickness skin. We conducted a retrospective case series study that included 12 patients with a scar of the cheek. The patients included seven females and five males. The donor site was treated using the cheek skin remaining in the scar area following repair of the cheek skin defect with a full-thickness skin graft from the inner side of the upper arm. Minor flap necrosis of the full-thickness skin graft in the cheek developed in one patient. The postoperative esthetic results were excellent and satisfactory in 11 and 1 patient, respectively. Patients were followed up for 18-32 months; no lagophthalmos or ectropion was noted. However, there were two cases of hyperpigmentation in cheek grafts, and two of graft hypertrophy in the arm. The facial skin remaining in the scar area can be used to treat donor site wounds following a full-thickness skin graft from the inner side of the upper arm to repair a large cheek skin defect.

Versatility of cervicofacial flaps: Cervical‐medial cheek flap for reconstruction in cutaneous substance loss of the inner cheek

Preservation of facial harmony is a major challenge in reconstruction after resection of head and neck skin tumors. For large medial cheek-skin defects, we used a derived posterior-based cervicofacial flap, or cervical-medial cheek flap (CMCF). We present a retrospective review of cases treated at a university-based cancer center. Patient characteristics, surgical technique, and complication rates are described. Eighteen patients were treated between 2014 and 2017 with reconstruction for integumentary cheek defect after skin tumor surgery using CMCF. Mean defect size was 5.7 cm in length and 3.9 cm in width. The main histological subtype was lentigo maligna (33.3%). We report no flap necrosis but 4 minor complications occurred over a mean follow-up of 14.4 months. At last follow-up, satisfaction rate was very high (88.9%) with no evidence of recurrence. The CMCF is a promising yet infrequently used option in medial cheek reconstruction, with excellent cosmetic and functional outcomes.

Paraffinoma induced bilateral preauricular cheek skin defects.

“Paraffinoma” is a well-recognized complication of paraffin oil injection into various body parts for an aesthetic purpose. After a variable latency phase, paraffinoma can present as a wide range of clinical symptoms. This paper is a case report of surgical excision of the paraffinoma and subsequent reconstruction of the associated skin defect on bilateral preauricular cheeks, manifesting 50 years after a primary injection.

Long-term outcome of the cheek advancement flap, a report of 41 cases

Background: Due to incidental occurrence of ectropion as a late complication of cheek advancement flaps, this study investigated the long-term effects of these flaps for post-Mohs’ reconstruction of the cheek aesthetic.Methods: All the patients who underwent a cheek advancement flap in the Catharina Hospital Eindhoven between January 2006 and January 2013 where included and assessed by means of a retrospective chart review and a survey about the long-term outcome and patient satisfaction.Results: A retrospective chart review was performed on all 54 eligible patients, and 41 (76%) of these patients participated in the study. The mean follow-up was 3.5 years (SD = 2.0, range = 1–7 years). Early complications were ectropion (6%), infection (2%), dog-ears (1%), haematoma (4%), and distal tip necrosis (2%). Late outcome and complications were sensory neuropathies (41%), late ectropion (7%), hypopigmentation of scars (29%), contractures (27%), and abnormal hair distribution (17%). Patients rated their reconstruction as good or excellent in 87% of cases.Conclusions: The cheek advancement flap is a suitable technique for reconstruction of large cheek skin defects after excision of skin malignancies. However, patients should be informed that long-term complications, including ectropion, can occur. Additional follow-up might lead to an early detection of these late effects.

Cheek reconstruction following facial malignant melanoma surgery with the platysma myocutaneous flap

The aim of this study was to evaluate the results of large cheek skin defect reconstruction using a superiorly based platysma myocutaneous flap accompanied by facial artery and vein preservation, following cutaneous head and neck melanoma surgery. This study offers new insight into a procedure that is a viable, but infrequently used reconstruction option. The authors report the cases of 13 consecutive patients with cheek skin defects following melanoma surgery who underwent reconstruction with a superiorly based platysma myocutaneous flap. The procedures were performed at a tertiary clinical centre and a national melanoma surgery referral centre between 2001 and 2008. According to the disease stage, eight patients underwent sentinel lymph node biopsy and five underwent comprehensive neck dissections. All of the patients were monitored for any complications related to the donor and recipient sites. Minor venous congestion of the flap was noted in two patients, with minor marginal skin necrosis in one patient. None of the patients had donor site complications. The superiorly based platysma flap proved to be a safe and reliable option for large cheek defect reconstruction, especially considering that it is a single-stage reconstruction procedure ensuring excellent colour-matching and low donor site morbidity.

Comparison of Local Flaps and Skin Grafts to Repair Cheek Skin Defects.

Background and Objective:Selecting the appropriate technique for surgical incisions, and reconstruction of facial defects after skin tumour excision has always been one of the surgeon's biggest concerns. The aim of this study is to compare the results between the local flap and skin graft to reconstruct cheek defects after basal cell carcinoma excision.Patients and Methods:In this retrospective study, 40 patients with skin defects resulting from skin tumour (Basal cell carcinoma) excision in cheek zones (16 sub-orbital, 18 bucco-mandibular and six auricular) were treated using local flap (n = 20) and skin graft (n = 20) from October 2010 to April 2012. All patients were followed up for 12 months, postoperatively. In addition, general assessments including complications, patient satisfaction, tissue co-ordination, skin colour and hospitalisation days were obtained.Results:Five patients had postoperative hyper-pigmentation complication in the skin graft group and none occurred in the local flap (P = 0.046). In the early postoperative period (2 weeks), mean scores in patient satisfaction, tissue co-ordination and skin colour were statistically significant increase in the local flaps (P < 0.001, P < 0.001, P < 0.001, respectively) and in the later postoperative period (12 months) only mean scores in skin colour significantly increased in the local flaps (P < 0.001). The mean postoperative length of hospitalisation days was 1.7 ± 0.4 days in the local flap group, and 3.63 ± 1.16 days in the skin graft group (P = 0.001).Conclusion:In the local flap group: Patient satisfaction, tissue co-ordination and skin colour were improved after 2 weeks. Also in 12-months follow up visits, skin colour was improved significantly and the hyperpigmentation was reduced. Generally, in this study the local flaps had better results in clinical outcomes and patient satisfaction. However, for each cheek defect the surgeon must choose the appropriate reconstruction strategy to avoid undesirable outcomes.

Lessons from 28 cases of reconstruction by lenticular island pedicle flap at a single institution.

Lenticular island pedicle flap (LIPF) has been reported to be one of the most useful techniques for reconstructing middle cheek skin defects. LIPF may have been used all over the world on a daily basis; however, no reports have examined a large number of LIPF cases at a single institution. A total of 28 cases of reconstruction by LIPF at the Hokkaido University Hospital from 2005 to 2013 were analysed. We examined the tumour type, location, area of defect and presence/absence of antithrombotic treatment and complications, including transient circulatory impairment, damage to facial nerves and eyelid ectropion. We found that nine patients had transiently impaired circulation. This complication was statistically more frequent in the patients without antithrombotic treatment than in the patients with antithrombotic treatment (0/8 vs. 10/20, P=0.0292; Fisher's exact test). We revelled that LIPF have been safely performed even under antithrombotic treatment, so, when patients are taking antithrombotic agents, we should choose LIPF rather than conventional flap including cheek flap, island pedicle flap and so on.

Neuroendocrine Differentiation of Primary Mucinous Carcinoma of the Cheek Skin

Neuroendocrine Differentiation of Primary Mucinous Carcinoma of the Cheek Skin

Reconstruction of cheek skin defects by the ‘Yin-Yang’ rotation of the Mustardé flap and the temporoparietal scalp

When the skin's laxity is limited, the preauricular cutaneous defect resulting from the Mustardé cheek rotation flap for the coverage of suborbital skin defects is very difficult to close even with a large undermining of the cervicofacial skin. The rotation of the temporoparietal scalp in an opposite direction compared to the Mustardé flap or the 'Yin-Yang' rotation of these flaps is interesting for two reasons: it allows an easy closure of this preauricular defect with a limited facial undermining and it suspends with efficiency the Mustardé flap at the temporal area avoiding the lower lid's ectropion. From September 2001 to April 2005, nine patients aged between 35 and 78 years old, with no facial skin laxity, have benefited from this technique to cover suborbital defects secondary to excision of basal cell carcinomas with a mean diameter of 6 cm. The design of the Mustardé flap was classical but the skin undermining stopped at the mandible's lower border. The triangular preauricular defect has served as a geometrical base to design an opposite temporoparietal rotation flap which is undermined under the galea. This technique has allowed an easy primary closure of all these defects. No complications were reported. With a mean follow up of 36 months the aesthetic quality of these reconstructions was satisfying and there was no malposition of the lower lid. This is a good technique for the simple coverage of medium-sized suborbital skin defects.

Reconstruction of full-thickness cheek defects with combined temporalis myofacial and facial-cervico-pectoral flaps

The objective of this study was to assess using the temporal myofacial flaps (TMFF) and the facial-cervico-pectoral flap (FCPF) to provide both inner and outer linings for large full-thickness cheek defects following ablative oral cancer surgery. Twelve patients with malignant tumors in the buccal region were treated by extensive surgical dissection, and the cheek mucosa defects were repaired with the TMFF and the cheek skin defects were reconstructed with the FCPF. There were 9 male and 3 female patients, age range from 18 to 70 years (mean 52.8). The full-thickness cheek defects ranged from 7 x 6 cm to 10 x 8 cm in size. No patient had complete loss of flap; 3 patients had minor complications (TMFF and FCPF partial necrosis and FCPF distal dehiscence) all of which settled with conservative management. Mouth opening was normal in 10 patients, and facial contour was satisfactory in 8 patients. The follow-up period varied from 6 to 26 months (mean 15.2); 3 tumors had local recurrences and 2 patients died from tumor metastasis. We found the technique to be anatomically sound, technically easy and reliable, and believe it is a useful method for the reconstruction of large full-thickness cheek defects.