New Horizons for the Puzzle Flap: A Multicenter Review of 35 Cases

The advancement flap known as the puzzle flap was first introduced by Goldberg et al. in 2005 as an alternative for small defects on the nasal ala. Although initially designed for this area, its application has been extended to other facial locations, such as the melolabial fold, auricular tragus and temple, with satisfactory aesthetic results.

The present retrospective study analyzed a total of 35 cases of puzzle flaps performed by dermatologists across Spain using the multicenter case collection platform known as CLINI-AEDV.

Most patients were women, with a mean age of 70 years. Basal cell carcinoma was the most common histological diagnosis. The most common tumor location was the nasal tip with 14 cases being reported out of 35, followed by other areas such as the nasal wing, the nasolabial fold and the retroauricular fold. Most cases, around 90%, did not exhibit immediate or late complications, with the trapdoor effect standing out as the most common complication among the rare ones. There were no recurrences of the excised lesions at the follow-up.

This study highlights the usefulness of puzzle flap in the reconstruction of facial defects, especially in the nasal tip and adjacent areas, as well as its successful application in other less common facial locations. Its low complication rate and absence of recurrences suggest that this technique can be considered a valid option in the surgical arsenal of every dermatologist for the reconstruction of facial skin defects.