The cheek-neck rotation flap for closure of temporozygomatic-cheek wounds

The head and neck surgeon is often consulted for evaluation and treatment of traumatic or neoplastic lesions of the lateral aspect of the face. Large malignant cutaneous lesions may require excision with wide margins, often parotidectomy, and possibly neck dissection. Traumatic lesions may involve notable soft-tissue loss, and parotid, facial nerve, or mandibular injury. Management of such planned or unplanned wounds challenges the surgeon due to the magnitude of the soft-tissue defect, cosmetic and functional considerations, and the need for soft-tissue protection and nourishment of repaired structures. Primary reconstruction with a large cheek-neck rotation flap provides the advantages of reliability, simplicity, excellent exposure, vital-structure protection, superior aesthetic results, and eliminates the need for a second operative site to harvest skin grafts or distant flaps. Four illustrative cases are reported, with a discussion to address parotid metastases from carcinoma of the lateral aspect of the face and initial treatment of shotgun injuries to the face.