Segmental reconstruction of the face.
BACKGROUND
Aesthetic facial reconstruction requires understanding regional anatomy and tissue movement and the ability to use innovatively the tissue adjacent to the defect to create a reconstruction that preserves the function of the area and the cosmetic facial units.


OBJECTIVE
Facial reconstruction after Mohs micrographic resection of nonmelanoma skin cancer confined to one cosmetic unit was compared with reconstruction of two or more units using techniques to place scars at the junction of cosmetic units with combinations of local flaps and grafts. Acute complications, function, and final appearance of the reconstruction were evaluated.


METHODS
During a 10-year period, 500 cases acquired prospectively had facial surgical defects repaired. Tissue was removed to place the closure line at the junction of cosmetic units and was mobilized from within one cosmetic unit with primary closure or local advancement, rotation, or transposition flaps. When the defect bridged cosmetic units, segmental repair was performed with combinations of flaps and grafts placing scars at the junction of cosmetic units. Segmental repair often combined advancement flaps to restore contours with full-thickness skin grafts to prevent distortion in areas with minimal loss of contour. Scars were more often unfavorably placed with single flap repair within a cosmetic unit. There was more flap loss with single flap repair of a single unit than with segmental facial repair using a combination of flaps and/or grafts.


CONCLUSIONS
Segmenting the wound into smaller units reflecting the underlying cosmetic units of the face was useful to develop a reconstruction plan to replace tissue with similar tissue and to provide consistently satisfying aesthetic results. Facial contours were restored without distorting surrounding structures.
Robinson
June K
JK
Departments of Medicine and Pathology, Cardinal Bernardin Cancer Center, Loyola University Stritch School of Medicine, Maywood, Illinois 60153, USA. jrobin5@lumc.edu
D000368:Aged; D005153:Facial Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008048:Lip Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D019651:Plastic Surgery Procedures; D012878:Skin Neoplasms / Q000601:surgery*; D016038:Skin Transplantation; D013524:Surgical Flaps