Closure of defects of the malar region

Reconstruction of the skin defects of malar region poses some challenging problems including obvious scar formation, dog-ear formation, trapdoor deformity and displacement of surrounding anatomic landmarks such as the lower eyelid, oral commissure, ala nasi, and sideburn.

Here, a new local flap procedure, namely the reading man procedure, for reconstruction of large malar skin defects is described.

In this technique, 2 flaps designed in an unequal Z-plasty manner are used. The first flap is transposed to the defect area, whereas the second flap is used for closure of the first flap's donor site. In the last 5 years, this technique has been used for closure of the large malar defects in 18 patients (11 men and 7 women) aged 21 to 95 years. The defect size was ranging between 3 and 8.5 cm in diameter.

A tension-free defect closure was obtained in all patients. There was no patient with dog-ear formation, ectropion, or distortion of the surrounding anatomic structures. No tumor recurrence was observed. A mean follow-up of 26 months (range, 5 mo to 3.5 y) revealed a cosmetically acceptable scar formation in all patients.

The reading man procedure was found to be a useful and easygoing technique for the closure of malar defects, which allows defect closure without any additional excision of surrounding healthy tissue. It provides a tension-free closure of considerably large malar defects without creating distortions of the mobile anatomic structures.