A Simple Approach for the Repair of Intermediate-to-Large Cheek Defects

Surgical management of cheek congenital melanocytic nevus (CMN) remains a huge challenge because of undesirable defects in repair. The use of direct closure is often limited to defect reconstruction with a diameter less than 4 cm.

This study aimed to evaluate the safety and efficacy of direct vertical closure combined with extensive subcutaneous tissue undermining boundaries for intermediate-to-large cheek defects.

A retrospective review was conducted to evaluate patients with cheek CMN who underwent the aforementioned procedure. Projected adult size, defect size, and incision length were measured. The Vancouver scar scale and visual analog scale were applied to assess scar formation and postoperative appearance. Complications within 1 year postoperatively were recorded.

A total of 35 patients with CMN >3.5 cm underwent the procedure. Patients' age ranged from 3 to 36 years. The average projected adult size of the facial CMN was 5.5 ± 1.6 cm. The mean Vancouver scar scale and visual analog scale scores were 2.6 ± 1.0 and 8.0 ± 0.7, respectively. There were 2 cases of dog ear deformity (5.7%) and 1 case of hematoma (2.9%).

This simple algorithm yields satisfying results with low complication rate in the repair of intermediate-to-large cheek defects and may become a useful alternative to cheek reconstruction.