Island pedicle and horizontal advancement cheek flaps for medial canthal reconstruction

To describe the surgical technique for and results of island pedicle cheek flap repair of medial canthal defects.

We retrospectively reviewed the charts of all patients with medial canthal defects repaired with island pedicle and horizontal advancement cheek flaps from November 2007 and July 2009. Patient demographics, risk factors for poor wound healing, diagnosis, operative findings, technique, and postoperative results were reviewed.

Twenty-five patients with a mean age of 61 years underwent reconstruction with island pedicle and horizontal cheek flaps. Basal cell carcinoma (88%), squamous cell carcinoma (8%), and melanoma in situ (4%) were the indications for surgery. Mohs micrographic surgery (76%) and radical excision with controlled margins (24%) were the methods of excision. Twenty percent of patients were smokers, 8% had diabetes, and 8% were systemically immunosuppressed. Mean defect diameter was 24 mm, and canalicular involvement was present in 3 cases. LactoSorb anchors were necessary for flap fixation in 16% of cases, and additional closure with glabellar rotation flaps was used in 20% of cases. Mean follow-up time was 13 months. Wound dehiscence, mild webbing, and mild ectropion were rare and required no secondary revisions.

The advantages of this technique include a well-vascularized pedicle, appropriate volume for filling the defect, and inferior support of the island pedicle flap with the horizontal advancement flap. The island pedicle cheek flap is a powerful and reliable technique for medial canthal defect reconstruction and allows good reconstruction of the natural canthal contour with low rates of minor complications.