Reconstruction of large facial defects using three or more local flaps

Free flaps, skin grafts, and local flaps are viable options for reconstructing large facial defects. When skin grafts, free flaps, or a single local flap are either not feasible or unlikely to yield satisfactory results, reconstruction can be performed using three or more local flaps. To evaluate the effectiveness of this surgical technique, this study analyzed the outcomes of reconstructions that utilized three or more local flaps.

This study included 10 patients who underwent facial reconstruction with three or more flaps following Mohs micrographic surgery (MMS) for skin cancer from 2016 to 2021. We investigated the types of flaps used, complications, and the recurrence rates of skin cancer. Patient satisfaction regarding color, contour, and scar was assessed through a questionnaire.

Of the 10 patients, nine underwent reconstruction with three flaps, while one patient required four flaps. There were no major complications such as flap loss. Partial necrosis occurred in one patient but was successfully managed with conservative treatment. There were no recurrences of the skin cancer that caused the initial defect, and overall patient satisfaction was high. Patients expressed high satisfaction with color, but lower satisfaction with contour and scar.

For large facial defects where free flaps or skin grafts would yield aesthetically or functionally inferior results, and reconstruction with a single flap is challenging, the application of three or more flaps has achieved good surgical outcomes. Utilizing three or more flaps can be considered a clinically useful method for reconstructing large facial defects.