title: Defects of the nose, lip, and cheek: rebuilding the composite defect.
abstract: BACKGROUND
  The face can be divided into regions (units) with characteristic skin quality, border outline, and three-dimensional contour. A defect may lie entirely within a single major unit or encompass several adjacent units, creating unique problems for repair. Composite defects overlap two or more facial units. Nasal defects often extend into the adjacent lip and cheek. The simplest solution may appear to be to simply "fill the hole"--just replace the missing bulk. Poor contour, incorrect dimension, malposition, asymmetry, poor blending into adjacent normal tissues, and a patch-like repair often follow.
  
  
  METHODS
  The following principles of regional unit repair were applied to guide these complex reconstructions: (1) reconstruct units, not defects; (2) alter the wound in site, size, shape, and depth; (3) consider using separate grafts and flaps for each unit and subunit, if appropriate; (4) use "like" tissue for "like" tissue; (5) restore a stable platform; (6) build in stages; (7) use distant tissue for "invisible" needs and local skin for resurfacing; and (8) disregard old scars.
  
  
  RESULTS
  Clinical cases of increasing composite complexity were repaired with local, regional, and distant tissues. Excellent aesthetics and function were obtained.
  
  
  CONCLUSIONS
  Careful visual analysis of the normal face and the defect can direct the choice, timing, and technique of facial repair. Regional unit principles provide a coordinated approach to the vision, planning, and fabrication of these difficult wounds. The entire repair should be intellectually planned, designed step by step, and laid out in a series of coordinated steps, with general principles applied to successfully repair composite defects of the nose, lip, and cheek.
authors.affiliation: Tucson, Ariz.
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Menick
mesh_terms: D002280:Basal Cell Carcinoma / Q000473:pathology / Q000601:surgery*; D002610:Cheek; D005153:Facial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008048:Lip Neoplasms / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009669:Nose Neoplasms / Q000473:pathology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D013536:Suture Techniques