Cervicothoracic flap for complex facial defect reconstruction: a case based approach

Reconstruction of complex facial defects following oncologic resection presents a significant challenge, especially when critical anatomical subunits and nerve branches are involved. The choice of reconstructive technique must prioritize tissue match, reliability, and safety. The cervicothoracic fasciocutaneous flap offers a valuable alternative to microsurgical reconstruction, providing robust vascular supply and favorable aesthetic integration without the need for microsurgical techniques. This report details the case of a 76-year-old male with micronodular basal cell carcinoma of the left cheek. Wide oncologic resection resulted in an 8 × 8 cm defect involving the infraorbital, preauricular, nasogenian, and mandibular units, as well as underlying structures including the SMAS and masseteric fascia. The defect was successfully covered using the cervicothoracic flap, with no complications such as necrosis or local infection. At four-month follow-up, the patient exhibited stable healing, good aesthetic integration, and only mild residual ectropion, with no functional limitations or donor site morbidity. This case highlights the effectiveness of cervicothoracic flaps in comorbid patients, positioning them as a viable alternative to microsurgical reconstruction for complex facial defects.