Comparison of local flaps and skin grafts to repair cheek skin defects

Abstract

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.

Donkey Bite Leading to a Catastrophic Outcome: Bilateral Visual Loss

“…In one study that compared complications, patient satisfaction, tissue co-ordination, skin color and hospitalization days between local flap and skin graft to reconstruct cheek defects, 20 patients were treated using local flap and 20 with skin graft. After 12 months of follow up, results showed local flaps had better results regarding clinical outcomes and patient satisfaction (19).…”

Outcome of flap surgeries in dermatosurgical unit at a tertiary care centre in India with a review of literature

“…[1] The size of the defect created, skin colour, tissue composition, location and subunits involved are the important factors to be considered while planning for the flap surgery. [2] For better aesthetic outcome, resection of the entire subunit is necessary if the defect involves >50% of the subunit. If all the layers are absent, a reconstruction of full-thickness graft has to be considered.…”

Approach to Reconstruction of Cheek Defects

“…Allowing a defect to heal by secondary intention is indicated for patients with defects less than 2 cm in diameter and for those who may not be able to tolerate or benefit from exhaustive reconstructive procedures. 2,5 Specifically, Zitelli 6 found that allowing defects located on concave surfaces to heal by secondary intention provides equal or superior cosmetic outcomes to that of more extensive graft and flap options. Therefore, for small superficial defects located on concave surfaces, healing by secondary intention is regarded as a first-choice option.…”

“…Like healing by secondary intention, primary closure is indicated for patients with defects less than 2 cm in diameter and for those who may not be able to tolerate or benefit from exhaustive reconstructive procedures. 2,5 Unlike healing by secondary intention, primary closure provides rapid closure and expedient healing. However, caution should be taken during primary closure for defects with tension along the periphery of the defect, as closure of the defect may introduce additional force vectors, resulting in the displacement of surrounding structures.…”