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An algorithm for the reconstruction of complex facial defects.

H B Gladstone¹, D Stewart

¹Division of Dermatologic Surgery, Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA.

Skin Therapy Letter

|March 30, 2007

Summary

Dermatologic surgeons can reconstruct complex facial defects after Mohs surgery using established principles. Key considerations include wound contraction, anesthesia techniques, and flap selection for optimal facial reconstruction outcomes.

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Area of Science:

Dermatologic Surgery
Plastic Surgery
Reconstructive Surgery

Background:

Mohs micrographic surgery often results in complex facial defects requiring reconstruction.
Reconstruction challenges include defect size, tissue loss, and proximity to critical structures.
Standard reconstructive principles apply to complex defects, with specific adaptations for facial anatomy.

Purpose of the Study:

To outline principles and techniques for reconstructing complex facial defects after Mohs surgery.
To discuss factors influencing reconstructive method selection.
To highlight when referral for complex reconstructions is necessary.

Main Methods:

Review of reconstructive techniques for facial defects post-Mohs surgery.
Discussion of flap selection, including workhorse flaps, tunneled pedicle flaps, and skin grafts.

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Consideration of adjunctive methods like artificial skin substitutes and tissue expansion.

Emphasis on the tumescent technique for large-area anesthesia.

Main Results:

Complex facial defect reconstruction relies on fundamental surgical principles.
Delayed closure for wound contraction is not always feasible, especially near fixed structures.
Flap choice is guided by defect location and size, with preference for versatile options.
Artificial skin substitutes and tissue expansion serve as options for extensive defects.

Conclusions:

Successful reconstruction of complex facial defects is achievable using tailored surgical approaches.
Careful consideration of wound characteristics and patient anatomy guides reconstructive decisions.
Knowing when to refer complex cases requiring general anesthesia or hospitalization is crucial for patient safety.