Inferiorly Based Rotation Flaps for Infraorbital Cheek Defects

Abstract

BACKGROUND The infraorbital cheek is a common location for cutaneous malignancy and thus surgical defects. Reconstruction in this region must maintain nearby free margins to ensure optimal cosmetic and functional outcomes. Large defects may require a flap using lateral or inferior tissue reservoirs. OBJECTIVE To examine outcomes of inferiorly based rotation flaps in the repair of infraorbital cheek defects and highlight pearls for optimal long-term results. METHODS Chart review of patients with a defect of the infraorbital cheek repaired with an inferiorly based rotation flap between February 2010 and December 2018 at a single academic institution. The Visual Analog Scale (VAS) was used for scar assessment. RESULTS Sixty-five patients underwent extirpation of a cutaneous malignancy resulting in defects ranging from 1.0 3 1.0 to 4.5 3 5.5 cm (mean area 5 4.8 cm 2 ). Most of the patients did not experience complications. Ectropion occurred in 7 patients. The mean VAS score was 11.6. CONCLUSION An inferiorly based rotation flap yields acceptable outcomes for infraorbital cheek defects and can be considered for defects as large as 5.5 cm. Using pearls for surgical execution presented in this article may allow reconstructive surgeons to include this flap in their repertoire.

State of the Evidence for Facial Skin Cancer Reconstruction

“…Laterally based flaps may reduce the risk of this, although success with inferiorly based rotation flaps for infraorbital defects have been documented. 89 In a retrospective review of 65 patients, inferiorly based flaps were used to repair infraorbital cheek defects up to 5.5 cm with acceptable cosmetic outcomes and a 10.8% rate of ectropion. 89 If inferiorly based flaps are used, periosteal anchoring sutures may reduce the risk of ectropion.…”

“…89 In a retrospective review of 65 patients, inferiorly based flaps were used to repair infraorbital cheek defects up to 5.5 cm with acceptable cosmetic outcomes and a 10.8% rate of ectropion. 89 If inferiorly based flaps are used, periosteal anchoring sutures may reduce the risk of ectropion.…”

Repair of a Large Infraorbital Cheek Defect

“…In addition, given the large size of the defect, a backcut into the medial inferior cheek was placed at the inferior aspect of the flap arc superior to the jawline to allow for additional movement, similar to the glabellar backcut in a dorsal nasal rotation flap. 5 The main standing cone was oriented laterally along the lower eyelid crease and crow's feet.…”

“…These tacking sutures, placed approximately 1.5 cm apart parallel to the eyelid margin helped minimize the risk of ectropion by anchoring the flap into the periosteum. 5 These tacking sutures were intentionally placed to upwardly displace the lower eyelid approximately 4-5 mm and eliminate lower scleral show at rest. Downward pull on the eyelid was tested by having the patient open her mouth and look upward.…”

“…Downward pull on the eyelid was tested by having the patient open her mouth and look upward. 5 Once downward pull of the eyelid was minimized, the flap was then secured using 4-0 and 5-0 vicryl and monocryl simple vertical interrupted dermal sutures. The standing cone was removed along the lateral eyelid margin.…”