Immediate Flap Reconstruction after Excision of Basal Cell Carcinoma of the Face

Head and Neck Malignant Melanoma

“…In other types of locally recurrent HN carcinoma, such as basal cell carcinoma, rates of inadequate excision are high and a cautious approach to immediate reconstruction has also been recommended. 13,30 Therefore, we suggest locally recurrent lesions be treated with the recommended wide excision margins and reconstruction should be delayed until pathology is reviewed and margins are clear of melanoma.…”

“…Some authors advocate for delayed reconstruction of HN carcinoma, such as squamous cell and basal cell carcinoma, until after review of permanently fixed pathology and confirmation of negative margin status, 11 whereas others argue that immediate tissue transfer reconstruction is safe. 12,13 Immediate frozen section analysis of melanoma margin status is not advised due to the challenging pathologic review of melanoma. Therefore, due to local recurrence concerns, the mainstay of HN cancer defect reconstruction has been delayed skin grafting after review of permanent pathology and immunohistochemistry.…”

“…This course of treatment is thought to ensure negative margins, enable surveillance of the original site, and not mask a local recurrence at the site of a more complex reconstruction. 11,[13][14][15][16][17][18] However, the often poor esthetic result and patient dissatisfaction with skin grafts due to color mismatch, contour deformity, wound contracture, and disfigurement along with inability to cover exposed cartilage or bone have driven us and others to prefer adjacent tissue transfer for HN reconstruction. 2,13 Adjacent tissue transfer has not been found to hinder monitoring for recurrence and may actually help prevent local recurrence by allowing larger and more oncologically sound margins to be taken.…”

“…11,[13][14][15][16][17][18] However, the often poor esthetic result and patient dissatisfaction with skin grafts due to color mismatch, contour deformity, wound contracture, and disfigurement along with inability to cover exposed cartilage or bone have driven us and others to prefer adjacent tissue transfer for HN reconstruction. 2,13 Adjacent tissue transfer has not been found to hinder monitoring for recurrence and may actually help prevent local recurrence by allowing larger and more oncologically sound margins to be taken. 12,19,20 The objectives of our study were to (1) determine the overall frequency of a positive margin and patient and tumor characteristics associated with a positive margin after WLE of cutaneous HN malignant melanoma, and (2) establish criteria for performing immediate versus delayed reconstruction.…”

The Cheek-Neck Rotation Flap for Closure of Temporozygomatic-Cheek Wounds

“…Generous undermining, skin advancement, and liberal nondelayed flap transfer are well tolerated. These flaps offer important advan¬ tages over skin grafts because they (1) carry their own blood supply, (2) decrease wound contraction, (3) pro¬ vide bulk (and lining if necessary), (4) offer superior protection for nerves, vessels, bone, and cartilage, (5) resist infection, (6) undergo minimal pig¬ ment changes, and (7) are aesthetical¬ ly superior to grafts. It has been noted empirically that random skin flaps in the face and neck can be made longer than in other parts of the body, so every effort should be made to design Case 3.…”