Reconstructing complex central facial defects involving multiple cosmetic subunits

Defects of the central face can pose significant reconstructive challenges and are some of the most frequently encountered defects in facial reconstructive surgery. Familiarity with the repair of such defects is essential. At our institution, we have found that a systematic approach to central facial defects allows for superior results. We present that approach here using several cases to demonstrate the intraoperative planning involved. The cosmetic units and subunits within the defect must be identified. The defect must then be assessed for structural defects and deep soft tissue defects, which can be repaired utilizing cartilage grafts and hinge flaps respectively. Superficial defects of the cheek, lip, and nasal sidewall can then be assessed and repaired, taking advantage of the available tissue reservoirs using adjacent sliding flaps. The remaining distal nasal defect can then be repaired, depending on size, with a full-thickness skin graft, a cheek interpolation flap, or if necessary, a paramedian forehead flap. This systematic approach to reconstructing central facial defects simplifies seemingly complex reconstructive challenges and optimizes results.