Search

This article describes the background and importance of scalp reconstruction. The relevant anatomy and neurovasculature will be discussed. Finally, the entire reconstructive ladder will be examined in its relation to scalp reconstruction and how to optimally reconstruct scalp defects., Competing Interests: Disclosures The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Skin cancers affecting the concha and antihelix are quite common, because of anterior auricular projection from the head and subsequent actinic exposure, leading to the need for effective ear reconstruction post-surgery. Various methods such as skin grafts, free tissue transplantation, and local flaps have been used. This study introduces a refined technique for concha-antihelix defect reconstruction, based on a minimally invasive modification of the revolving-door flap procedure. Here, a fasciocutaneous flap technique involving minimal posterior auricular muscle contribution is used, particularly suitable for anterior skin and cartilage defects. The study included 75 patients with nonmelanocytic skin carcinoma on the ear's anterior surface, in which we evaluated patient's and surgeon's satisfaction with a visual analogue scale and discussed the surgical technique and its advantages and indications. The technique demonstrated excellent cosmetic and functional outcomes, effectively hiding donor-site deformities and ensuring patient and surgeon contentment. This approach allows for one-stage reconstruction under local anesthesia, reducing costs, surgery time, and recovery period. The procedure provides high-quality tissue for reconstruction with low complication risks, making it an optimal choice for wide conchal and antihelix defect repairs due to its proximity to the affected area and the reliable, swift nature of the method., Competing Interests: Declarations of interest None., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Background: Scalp reconstruction is a challenging field for plastic surgeons. In case of large or complex defects, microsurgical-free flaps are usually required. Reconstructive failure can result in high morbidity and in some cases be life-threatening. In this article, we present our experience in the reconstruction of complex scalp defects with the use of a vastus lateralis (VL) free flap., Patients and Methods: From July 2013 to July 2023, we retrospectively analyzed patients who underwent soft tissue reconstruction of the scalp with a VL-free flap at the authors' institution. The patient's demographic, clinical and surgical characteristics, and postoperative complications were recorded and analyzed., Results: Thirty patients were included. The mean age was 67.3 years. Seventeen patients were male, while 13 were female. In 56.7% of patients, defects resulted from cancer resection. In four patients, the defect was limited to the soft tissues while a multi-layer defect with bone and/or dura involvement was present in 26 patients. Soft tissue reconstruction was always achieved with a VL-free flap (n = 30). In 28 cases, a skin-grafted muscular flap was used. The most used recipient vessels were the superior thyroid vessels (n = 18). Complications occurred in six patients (20%): two cases of total flap loss and two cases of infection of the cranioplasty materials requiring their removal. In two cases patients died within 48 h. All patients were satisfied with the aesthetic and functional results at 6 months., Conclusions: In the case of complex scalp defects, the gold standard is reconstruction through microsurgical flaps that provide well-vascularized tissue and allow to cover large defects, reducing the incidence of infections and ensuring good brain protection even without cranioplasty. In our experience, VL-free flap represents a valid option, providing a low donor site morbidity, the possibility of a two-team approach, and a low complication rate., (© 2025 The Author(s). Microsurgery published by Wiley Periodicals LLC.)

The reconstruction of full-thickness scalp defects with exposed bone can be challenging. A single-stage reconstruction could be the preferred option for patients with multiple comorbidities. We propose using a dermal regeneration template (Matriderm Flex) and full-thickness skin grafts. The approach shown in this case report allows for quick healing, less donor-site discomfort in comparison with dermatome-harvested skin grafts, and very good aesthetic results, matching the surrounding skin thickness., (© 2024 The Author(s). Australasian Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Australasian College of Dermatologists.)

Keratinocyte carcinomas (KCs) are commonly located on the scalp and often treated with excision with peripheral and deep en face margin assessment (PDEMA), with Mohs micrographic surgery (MMS) being the most frequently used method. Resection of these malignancies results in wounds with a wide variety of sizes, ranging from small, sub-centimeter defects, to extensive, nearly complete scalp defects. MMS is often the preferred treatment for tumor resection and margin clearance, as it allows for maximal healthy tissue preservation and has the lowest recurrence rates. Multiple local flap reconstruction options exist, and the selection depends on the size and location of the defect. This review highlights the indications, typical locations, potential risks, and advantages of frequently used local flaps on the scalp, accompanied by artistic representations of each flap herein. An exhaustive list of the local scalp flaps discussed in this review includes single, bilateral, and triple rotation flaps, the pinwheel flap, the double hatchet flap, the triple rhomboid flap, both the unilateral and bilateral banner flaps with split thickness skin grafts, A to T flaps, H-plasty flaps, single and double bridge flaps, and the pacman flap. Inelasticity of the scalp inhibits tissue movement so flaps on the scalp must be designed to be much larger than flaps in most other facial locations. One of the greatest benefits of working with local flaps on the scalp is often the presence of hair-bearing skin which provides the reconstructive surgeon the ability to hide significant scars under hair-bearing scalp, and the ability to perform wound repair under local anesthetic immediately following tumor removal by MMS., Competing Interests: Declarations. Patient consent: Not applicable. Competing interests: The authors declare no competing interests. IRB approval: Exempt., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Several local skin flaps and tissue rearrangement techniques have been described in the literature, including the rhomboid flap. The Limberg flap is one of the most versatile local flaps that can be used for reconstruction of a wide range of skin defects in different parts of the body. The purpose of this study is to demonstrate the safety and applicability of the Limberg flap for reconstruction of skin facial defects, particularly after cutaneous tumor resection. The following article presents a retrospective case series of 8 patients in whom the Limberg flap was used to reconstruct skin defects resulting from malignant tumor resections in the lateral part of the face. No restrictions were collected regarding etiology, location, size, age, sex, or any other patient factors. The recruited patients were treated in the Maxillofacial Surgery Unit of Floraspe Renzetti Hospital of Lanciano and the study was conducted in collaboration with Sapienza University of Rome, from April 2023 to April 2024. All the flaps settled with no complications and all the patients were FOD (free of disease) 6 months after surgery. So, in accordance with the literature, the Limberg flap turns out to be a rapid and reliable option that could be easily applied for small (size around 1-2 cm) and medium-sized (size around 2-4 cm) cutaneous defects of the face even for the oldest and/or emaciated patients., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Background: Basocellular carcinoma (BCC) is the most prevalent skin malignancy, often localizing to the UV-exposed skin of the face. While most BCC is relatively indolent, aggressive subtypes, including infiltrative BCC, pose the treatment challenges of ensuring functional and aesthetic preservation with a high risk of recurrence., Case: A 78-year-old female patient complained of recurrent left chin BCC of infiltrative subtype, which was first treated in 2013 by wide local excision and adjuvant radiotherapy. Recurrent carcinoma was reported in 2017, 2021, and most recently in 2023. The most recent recurrence presented with scar contracture, facial asymmetry, and drooping of the lip. Surgical resection involved extensive excision of the lower lip and chin, exposing the mandible. Reconstruction was achieved with the help of bilaterally designed Karapandzic flaps for the lip and a bilobed rotational flap for the chin defect. Although no chemotherapy and immunotherapy were given, the functional and aesthetic result were satisfactory. The procedure was executed while preserving the pertinent neurovascular structures, maintaining oral competence, and restoring the lower face. The Karapandzic flap was helpful in maintaining the lip function, whereas the chin was reconstructed using the bilobed rotational flap. Post-operative histology confirmed the diagnosis of BCC with squamous differentiation, which had clear margins. The patient did well and the cosmetic and functional outcome was satisfactory without any disease at 18 months after surgery., Conclusion: This case sheds light on the difficulties encountered in treating recurrent facial BCC in developing countries. In the absence of systemic therapies, advanced surgical techniques and intensive follow-up resulted in a long disease-free period with good functional and aesthetic outcomes, thanks to the successful use of innovative reconstruction even in a low-resource setting., (© 2025 The Author(s). Cancer Reports published by Wiley Periodicals LLC.)

Melanoma of the lentigo maligna (LM) type is most commonly located on the head and neck region. This subtype of melanoma poses surgical challenges due to its location on anatomically sensitive areas and frequent presence of subclinical extension. To analyze the reconstruction patterns of LM patients undergoing margin-controlled surgery. An observational study was conducted at Memorial Sloan Kettering Cancer Center, enrolling patients who underwent staged excision for the LM between November 2006 and April 2019. The study included 519 patients. Following margin-controlled surgery, the size of the surgical defects varied: <10 mm(36.2%), 10 and 30 mm (36.8%), and > 30 mm (27%). A flap reconstruction was the most common reconstructive technique (42.6%), followed by primary closure (32.6%), and graft (21.8%). Age was significantly associated with reconstruction type, with older patients more likely to undergo graft reconstructions (p = 0.014). Larger defects (> 30 mm) were reconstructed with grafts and flaps more often compared to smaller defects (p < 0.001 and p = 0.02, respectively). Understanding the scope of reconstruction is important for effective pre-surgical counseling and treatment planning. These findings highlight the importance of personalized strategies considering patients' age and defect size., Competing Interests: Declarations. IRB approval status: N/A. Prior presentation: None. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background and Objectives : The lateral arm flap has been a very useful choice for the reconstruction of small to medium-sized defects, such as in the hands, extremities, and oral head and neck area. Its versatile characteristics and surgical feasibility allow this flap to be widely applied, but its reconstructive potential in the facial subunit after tumor ablation procedures has never been reported. In this study, we aimed to utilize the advantages of this flap to carry out facial temple subunit defect reconstruction. Materials and Methods : Between 2020 and 2023, 12 patients underwent temple reconstruction with lateral arm free flaps after wide malignant tumor excisions. There were seven women and five men, and the mean patient age was 60.6 years. Among the patients with cancer, six had squamous cell carcinoma, five had basal cell carcinoma, and one had myxofibrosarcoma. All flaps were elevated under general anesthesia. Alprostadil (PGE1, Eglandin ® , Mitsubishi Tanabe Korea, Seoul, Republic of Korea) was administered postoperatively. Results : All flaps were the fasciocutaneous type, with sizes that varied from 3 cm × 4 cm to 5 cm × 7 cm (average size: 22.7 cm 2 ). The average pedicle length was 6.1 cm. The versatility of the lateral arm flap enabled successful coverage in all cases, with no specific complications. Good functional outcomes and good ranges of motion in the donor arms were observed after surgery. Conclusions : The authors successfully verified the advantages of lateral arm flaps in the treatment of medium-sized facial temple subunit defects.

Objective: Reconstruction of skin cancer and Mohs micrographic surgery (MMS) defects of the head and neck is performed in both in-office and operating room (OR). This study intends to understand cost differences between reconstructive surgery for skin cancer defects in the OR and clinic to perform a cost-effectiveness analysis with single-institution patient satisfaction data., Study Design: Population-based retrospective analysis of cost data and an institutional, prospective survey of patient satisfaction., Setting: National insurance database and institutional survey., Methods: The Merative® MarketScan database was queried to identify claims involving the reconstruction of skin cancer defects of the head/neck between 2013 and 2020 for cost-analysis by setting (OR vs clinic). Patients undergoing operative and clinic-based reconstruction of MMS defects by 3 different surgeons at a single institution in 2023 were surveyed for satisfaction using a 5-point Likert scale. Data was coupled for cost-benefit analysis. Analysis was performed using propensity-matched samples., Results: Using Marketscan, 1206 patients were analyzed for cost data. OR cases had a higher median baseline cost of $2308 (interquartile range [IQR]: 1484-3889) compared to procedures in the office (median $987, IQR: 784-1454, P < .001). Survey data from 116 patients revealed no significant difference in scores between OR and clinic cases (clinic: 4.57 vs OR: 4.60, P = .8752). Using propensity-matched subsets, providers incur an additional $4744 for a reduction in satisfaction of 0.083 when performing cases in the OR., Conclusion: Lower cost is associated with reconstructive procedures performed in the office. This study is the first cost analysis of head and neck skin cancer reconstruction based on procedural settings and will be valuable to surgeons in considering practice patterns and resource utilization., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Background: Reconstruction of skin defects after oncological surgery for a cutaneous squamous cell carcinoma is often mandatory to facilitate adjuvant treatment and/or to prevent chronic wound problems. Some of the most challenging regions to reconstruct after resection of a skin tumor are the frontal and parietal parts of the skull., Methods: This article describes three patients with large skin defects after oncological surgery that were reconstructed with the use of a (hemi) visor flap., Results: The (hemi) visor flap is easy to harvest, resulting in a concise procedure and short hospitalization with maximum wound control., Conclusion: The (hemi) visor flap is a safe and reliable option for the closure of large skin defects on the skull. Especially in the older and frail patient group., (© 2024 The Author(s). Head & Neck published by Wiley Periodicals LLC.)

Purpose: Scalp full-thickness defects reconstruction following the resection of skin carcinoma poses significant challenges due to scalp anatomy complexity and limited vascularity. Despite various techniques available, including tissue expansion and local flaps, no single method stands as the gold standard. Moreover, cases requiring adjuvant radiotherapy further complicate reconstruction, demanding durable solutions. This study explores the efficacy of Integra ® Dermal Regeneration Template Single Layer (Integra DRTSL) followed by split-thickness skin grafting (STSG) in one-stage scalp reconstruction post oncologic resection., Methods: A retrospective analysis was conducted on patients undergoing this procedure from January 2020 to October 2023. Surgical outcomes, including graft take rates, complications, and adjuvant therapy tolerability, were assessed., Results: Results demonstrated successful reconstruction in the majority of cases, with a complete graft take rate of 77% and minimal complications. Notably, the single-stage approach facilitated timely initiation of adjuvant therapy, crucial for oncologic management. Healing times were notably reduced (< 60 days), enabling early radiotherapy commencement. No local recurrences were observed during the 16-month follow-up., Conclusion: The use of Integra DRTSL with STSG in one-stage reconstruction presents a promising alternative, offering optimal cosmetic and functional outcomes with low complication rates. This approach streamlines the reconstruction process, ensuring timely adjuvant therapy initiation and maximizing patient outcomes, especially in the context of scalp cutaneous tumors requiring radiotherapy., Clinical Trial Number: This research was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of University of Campania "Luigi Vanvitelli" (protocol code N. 0013333, 29 April 2021)., (© 2024. The Author(s).)

Background: The rates and risk factors for wound complications following staged reconstruction after facial lentigo maligna (LM) resection have not been well described. Objectives: (1) To identify the rate and types of wound complications, including infection, graft necrosis, distal flap necrosis, hematoma, superficial epidermolysis, and seroma among patients undergoing staged reconstruction after resection of LM as documented in the surgeon's clinical notes within 30 days of the procedure. (2) To determine a threshold defect size that may predict the development of wound complications. Design and Outcomes: Retrospective review at an academic medical center of patients who underwent staged reconstruction after facial LM resection over a 5-year period. Results: Ninety-eight patients were identified with a mean age of 69.2 ± 13.6 years; 37% of patients were female. The most common defect sites were the cheek ( n = 41; 42%) and nose ( n = 22; 22%). Twenty-five of 98 patients (26%) demonstrated complications, with the most common being wound infection (36%) and graft necrosis (24%). Those receiving perioperative antibiotics had lower rates of complication (odds ratio [OR]: 0.36; 95% confidence interval [CI]: 0.13,0.96; p = 0.041). Defects greater than 2.7 cm in maximal diameter had the highest sensitivity for predicting complications. Conclusions: Patients undergoing staged reconstruction after facial LM resection have a high rate of wound complication (26%) and defect size > 2.7 cm may be an important risk factor.

Background: ChatGPT is an open-access chatbot developed using artificial intelligence (AI) that generates human-like responses., Objective: To evaluate the ChatGPT-4's concordance with three dermatological surgeons on reconstructions for dermatological surgical defects., Methods: The cases of 70 patients with nonmelanoma skin cancer treated with surgery were obtained from clinical records for analysis. A list of 30 reconstruction options was designed by the main authors that included primary closure, secondary skin closure, skin flaps and skin grafts. Three dermatological surgeons who were blinded to the real reconstruction, along with ChatGPT-4, were asked to select two reconstruction options from the list., Results: Seventy responses were analysed using Cohen's kappa, looking for concordance between each dermatologist and ChatGPT. The level of agreement among dermatological surgeons was higher compared with that between dermatological surgeons and ChatGPT, highlighting differences in decision making. In the selection of the best reconstruction technique, the results indicated a fair level of agreement among the dermatologists, ranging between κ 0.268 and 0.331. However, the concordance between ChatGPT-4 and the dermatologists was slight, with κ values ranging from 0.107 to 0.121. In the analysis of the second-choice options, the dermatologists showed only slight agreement. In contrast, the level of concordance between ChatGPT-4 and the dermatologists was below chance., Conclusions: As anticipated, this study reveals variability in medical decisions between dermatological surgeons and ChatGPT. Although these tools offer exciting possibilities for the future, it is vital to acknowledge the risk of inadvertently relying on noncertified AI for medical advice., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Secondary intention healing has been a well-established method to close wounds for more than 200 years. Indeed, it represents the easiest technique in the ladder of plastic reconstruction. Primary wound closure (side-to-side closure, direct wound closure) is the second easiest method. The combination of these two techniques is already an integral aspect of specific surgical procedures, e.g. the reconstruction of the donor site of a paramedian forehead flap. This minireview will show that the combination is also a suitable alternative to classic flaps in reconstruction of different aesthetic subunits of the face. These are the scalp, the lateral cheek, the upper nasal sidewall/medial canthus and the retroauricular region. The advantages and disadvantages will be discussed and illustrated with clinical examples., (© 2024 Deutsche Dermatologische Gesellschaft (DDG).)

Background: Large involuted infantile hemangioma remains a challenge in facial reconstruction. The characteristic fibrofatty residuum and multiple subunits/tissues involvement contribute significantly to the difficulty of surgical management. Tissue expander plays an important role in facial reconstruction, allowing plastic surgeons to repair skin damaged by both congenital and acquired defects., Methods: Between 2009 and 2021, 30 patients who underwent tissue expansion surgery were reviewed in a single hospital. The demographic data, lesion characteristics, surgical approaches, complication rate, and aesthetic outcomes were analyzed., Results: Thirty patients (5 men and 25 women) with a mean age of 14.03 ± 7.25 years (range, 4-33 years) were included. The mean follow-up is 35.92 months, ranging from 9 to 75 months. Tissue expansion-related complications include closed infection, 2/30 (6.67%); skin ischemia, 2/30 (6.67%); hematoma, 1/30 (3.33%); flap necrosis, 1/30 (3.33%)., Conclusion: Large facial involuted infantile hemangiomas have variable patterns of presentation and necessitate tailored therapy. Tissue expansion is a reproducible approach to achieving aesthetic reconstruction., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background and Objectives: Cutaneous squamous cell carcinoma is the second most common skin cancer. There are many methods for the reconstruction of facial subunit defects after skin cancer excision. The face is vital to a person's life and should be reconstructed considering functional and aesthetic aspects. Despite a variety of flap types and techniques, it is still challenging to meet the various demands. The aim of this study was to compare free flaps for facial reconstruction after resection of cutaneous squamous cell carcinoma. Materials and Methods: This study included 14 patients from January 2021 to June 2023. Patients who underwent facial SCC resection and subsequent reconstruction using free flaps were analyzed retrospectively. Age, sex, and localization were recorded. Follow-ups ranged from 5 to 21 months, with an average of 13 months. Results: All free flaps survived well except one case of partial flap necrosis. In most patients, good to excellent functional and aesthetic results were obtained. The donor site healed uneventfully in all patients. Conclusions: Free flap reconstruction is an excellent choice in wide skin oncologic defects. In terms of texture, it also could be a good surgical method. The use of a fraxel laser can progressively facilitate improved color matching with the surrounding skin.

Background: The closure of scalp wounds presents with reconstructive challenges due to the poor tissue elasticity. It is not uncommon to require skin grafts for definitive closure, even when large flaps are employed. Herein, we present a novel method for the direct closure of small- to medium-sized wounds defects. It is a modified bilateral rhomboid flap, which enables tension-free closure in many areas of scalp., Methods: All patients treated with this technique between January 2018 and January 2023 were reviewed. Demographics, complications, and outcomes were reviewed., Results: One hundred forty patients have been operated with this technique. All have been cases of skin tumors. The full flap survival was 97.14%, and they did not present any major local complications, avoiding in all cases the use of skin autografts. Four patients (2.86%) had partial necrosis in the edges of the flap, all managed with topical wound care with good healing and no need of secondary procedures., Conclusions: This flap is safe and easy to perform when there is skin laxity in the scalp. It can save many skin grafts, simplifying the closure of this area, which can be a first-choice technique on scalp reconstruction., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Non-graftable or composite defect reconstruction represents a major challenge to the reconstructive surgeon, with many wounds requiring local flap or free microvascular tissue transfer approaches. The recent advent of synthetic skin substitutes such as Biodegradable Temporizing Matrix (BTM) have revolutionized the management of complex defects including those caused by burns, trauma and infection, with low-morbidity and low-complexity surgery. However, limited data exist supporting their use in cancer reconstruction in Australia., Methods: We performed a prospective cohort study of patients undergoing cancer resection and reconstruction with BTM between February 2021 and February 2023 in our institution. Reported outcomes included matrix integration, infection, and return to theatre., Results: Twelve patients underwent reconstruction of primary or secondary defects following cancer resection during this period. Eight patients were male, four female, mean age at surgery was 70 years. Pathology resected included squamous cell carcinoma (SCC) and melanoma of the head and neck, sarcoma resection of the lower limb, and osteoradionecrosis (ORN) of the scalp. T-stage of primary tumours ranged from T2 to T4 and one in-transit metastasis of melanoma. Four patients were treated with radiotherapy, two of whom received postoperative radiotherapy (PORT) and two who received neoadjuvant radiotherapy, three additional patients had an intervention to a previously irradiated wound bed for recurrence or ORN. Overall matrix integration was 83% (10/12), with a 50% integration rate (2/4) observed in the post-radiotherapy group, requiring return to theatre for alternative reconstructive approaches., Conclusion: We report our experience with a synthetic dermal matrix (BTM) in cancer reconstruction, the largest cohort of this type in the Australian literature. BTM represents an exciting reconstructive tool for the cancer reconstructive surgeon, with a high rate of success and low morbidity., (© 2024 Royal Australasian College of Surgeons.)

The internal mammary artery perforator (IMAP) flap has been widely used for chest wall and neck reconstruction. The color of its skin paddle closely resembles that of facial skin, making it attractive for facial reconstruction. However, there has been insufficient investigations reporting the use of free IMAP flap. Furthermore, even in such studies, somewhat invasive procedures, including rib cartilage resection, were employed to ensure sufficient pedicle length, potentially increasing donor morbidity. Our report presents two cases of successful facial defect reconstruction using a free IMAP flap harvested with minimal donor site damage, showing its feasibility. In the first case, a 48-year-old male underwent wide excision for a malignant melanoma on his right cheek, resulting in a 4 × 4.5 cm full-thickness defect. A free IMAP flap with a 2.5 cm pedicle, was harvested without rib cartilage resection, preserving IMA main trunk, and transferred with anastomosed to the angular vessels within the defect. The second patient presented with a 4.5 × 3.5 cm basal cell carcinoma on the left cheek, necessitating wide excision and leaving a 6 × 5 cm defect. A free IMAP flap was harvested with the same approach and successfully reconstructed the defect with connected to the superficial temporal vessels using vascular bridge. Both patients were discharged complication-free, with no recurrence during 24 and 15 months of follow-up, respectively. They were highly satisfied with the final skin color and texture outcomes. Harvesting a free IMAP flap while minimizing donor morbidity may offer an attractive option for facial reconstruction., (© 2024 Wiley Periodicals LLC.)

Introduction: The use of free-style and propeller perforator-based flaps has been popularized for the reconstruction of moderate size defects in the trunk and extremities, while their application in the field of abdominal reconstruction is seldom reported. The purpose of this report is to describe the authors experience with the use of pedicled perforator-based flaps in abdominal wall reconstruction, presenting the innovative concept of transition from angiosomal to bi-angiosomal and extra-angiosomal perforator flaps and showing applications of the different flap designs according to the multiple clinical scenarios., Patients and Methods: A total of 15 patients underwent abdominal wall reconstruction with angiosomal, bi-angiosomal, and extra-angiosomal pedicled perforator-based flaps harvested from the surrounding abdominal subunits for superficial or full thickness defects of the abdominal wall of moderate and large dimensions. The defects were consequent to soft-tissue sarcomas (STS) and non-melanoma skin cancer (NMSC) resection in 11 and 4 cases, respectively. Operative data, post-operative course, and complications were recorded. Moreover, at 12 months follow-up, patients were asked to rate the esthetic and functional outcomes of the reconstructive procedure on a 5-point Likert scale., Results: Ten angiosomal perforator flaps (4 DIEP, 4 SCIP, 1 SEAP, and 1 LICAP flaps) and 5 bi-angiosomal and extra-angiosomal conjoined perforator flaps including different vascular territories (3 bilateral DIEP, 1 bilateral SEAP, and 1 ipsilateral DIEP-SEAP flap) were successfully transferred in 15 patients. In two patients, microsurgical anastomoses were performed to guarantee proper vascularization of the additional cutaneous territory. Mean age was 59.3 years. Defect sizes ranged from 98 to 408 cm 2 (mean size was 194.7 cm 2 ). Mean operative time was 280 min. Flap surface ranged from 108 to 336 cm 2 (mean surface was 209.3 cm 2 ). No major complications were registered. One bi-angiosomal bilateral DIEP flap suffered from partial necrosis and required an additional flap reconstruction. All patients underwent a 12-month follow-up except one, who did not show for clinical follow-up but responded at the Likert scale at clinical follow-up at 9 months. Overall patients' satisfaction was high, with mean esthetic and functional ratings of 4.27 and 3.87., Conclusion: The use of local tissues is an under-utilized solution in the field of abdominal wall reconstruction. Angiosomal, bi-angiosomal, and extra-angiosomal perforator flaps proved to be a reliable option to provide the transfer of a significant amount of tissue and offer like with like reconstruction while maximizing flap survival., (© 2024 The Author(s). Microsurgery published by Wiley Periodicals LLC.)

Introduction: Surgical therapy of basal cell carcinomas (BCC) is based on complete excision of the neoplasm and its immediate suitable reconstruction. The aim of this work was to evaluate the possibility of creating a reconstructive algorithm in cases of scalp BCC, depending on the amplitude of the tumor., Evidence Acquisition: A literature search was carried out using the databases of PubMed, Scopus and Cochrane., Evidence Synthesis: Based on the experiences reported in the literature, it was possible to structure a decision-making algorithm that summarizes the various steps involved in the choice of the most suitable reconstructive surgical therapy., Conclusions: The algorithm described we hope will be of reference or help to less experienced reconstructive plastic surgeons.

Background: Transposition flaps are commonly used for facial-defect repair after wide excision of skin cancers. However, such repair often causes excessive tension at the donor site that can result in distortion of the adjacent area. The hatchet flap, a rotation-advancement flap, can prevent distortion by redistributing the donor site tension evenly to the recipient site. This study aims to compare the esthetic outcomes of the hatchet flap and transposition flap in facial-defect reconstruction., Methods: We retrospectively included 50 patients who underwent facial reconstruction with the hatchet flap or transposition flap after excision of skin cancer. They were followed up for more than 6 months. At the last follow-up visit, the esthetic outcome was evaluated by subjective and objective assessments using the patients and observer scar assessment scale and Manchester scar scale., Results: Thirty patients and 20 patients underwent reconstruction using the hatchet flap and the transposition flap, respectively. The total score from the patient and observer scar assessment scale was significantly lower in the hatchet flap group compared with the transposition flap group (p = 0.009). The Manchester scar scale showed a total score of 7.67 ± 2.2 for the hatchet flap and 9.95 ± 1.99 for the transposition flap: in the color (p < 0.001), distortion (p < 0.001), and texture (p < 0.02) categories, the hatchet flap yielded significantly better outcomes than the transposition flap., Conclusions: The hatchet flap had good esthetic outcome for facial reconstruction and could be a valuable option for reconstructing facial defects., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Surgical treatment of large and giant congenital melanocytic nevi (GCMN) of the upper extremity is challenging because of limited options for reconstruction. A preexpanded distant flap is considered an important option in upper extremity reconstruction, where the soft tissue available for use is limited. The authors aimed to refine the preexpanded distant flap after excision of the GCMN in the upper extremity., Methods: Large (>10 cm) and giant (>20 cm) congenital melanocytic nevi of the upper extremities treated with tissue expansion and distant flaps over 10 years were retrospectively reviewed, and the authors describe in detail the surgical strategies for reconstruction of the upper extremity with a distant flap., Results: From March of 2010 to February of 2020, 13 patients (mean age, 2.87 years) treated with 17 preextended distant flaps were included. The mean flap dimension was 154.87 cm 2 , ranging from 15 × 5 to 26.5 × 11 cm. All procedures were successfully completed except for one, in which partial flap necrosis occurred. Preconditioning was performed before flap transfer in 5 patients with larger rotation arcs and flap dimensions. The mean duration of postoperative follow-up was 51.85 months. A new reconstructive protocol was proposed that combined the 3 elements, including a distant flap, tissue expander, and preconditioning., Conclusions: In the treatment of GCMN in the upper extremities, careful planning and multiple stages are required. For pediatric patients, the preextended distant flap with preconditioning is useful and effective for reconstruction., Clinical Question/level of Evidence: Therapeutic, IV., (Copyright © 2023 by the American Society of Plastic Surgeons.)

Introduction: Tranexamic acid (TA) has attracted increased attention among surgical specialties, but its use in plastic surgery is limited. The aim of this study was to assess the efficacy and safety of topical administration of 3% TA solution in reconstructive surgery of the face and scalp after excision of skin cancers., Methods: a randomized, double-blind, parallel-group clinical trial was conducted in patients aged 18 years or older with malignant skin neoplasms in the face or scalp region (ICD-10 C44.9). The primary outcome was volume of blood loss in the intraoperative and immediate postoperative period. Secondary outcomes included difficult-to-control intraoperative haemorrhage, hematoma, ecchymosis, and other adverse events., Results: of the 54 included patients, 26 were randomised to TA group and 28 to placebo group. The mean blood loss was 11.42ml (SD 6.40, range 8.83-14.01) in the TA group, and 17.6ml (SD 6.22, range 15.19-20.01) in the placebo group, representing a mean decrease of 6.18ml (35.11%) (p=0.001). TA significantly reduced the risk of ecchymosis (RR = 0.046; 95% CI: 0.007-0.323). Only two patients in the placebo group experienced ischemia in the flaps, and one patient in the placebo group experienced tissue necrosis requiring surgical reintervention. There were no surgical wound infections, thromboembolic phenomena, or other adverse events related to TA., Conclusions: topical TA may reduce intraoperative and immediate postoperative bleeding, with a significantly decreased risk of ecchymosis. There is no evidence of ischemic damage of flaps, systemic thromboembolic complications, or other adverse events.

Background: Scalp defect reconstruction poses considerable challenges, with ongoing debates regarding the most effective strategies. While the latissimus dorsi (LD) flap has traditionally been favored, the anterolateral thigh (ALT) flap has been well described as a versatile alternative for addressing extensive scalp defects. This study underscores the success of scalp reconstruction using ALT flaps, notably pushing the boundaries of previously reported flap sizes. Our approach leverages the use of indocyanine green (ICG) perfusion to guide precise preoperative planning and vascular modification, contributing to improved outcomes in challenging cases., Methods: We performed 43 ALT flap reconstructions for scalp defects between 2016 and 2023. We collected patients' demographic and clinical data and evaluated flap size and recipient vessels and additional surgical techniques. Detailed preoperative plans with ultrasound and ICG use for intraoperative plans were performed to find perforators location. The cohort was divided into two, with or without complications on flaps, and analyzed depending on its surgical details., Results: This study involved 38 patients with extensive scalp defects (mean age: 69.4 ± 11 years) who underwent ALT perforator flap transfers (mean flap size: 230.88 ± 145.6 cm 2 ). There was only one case of unsuccessful flap transfer, and four cases had a few complications. The characteristics of the complication group included a large flap size (303.1 ± 170.9 vs. 214.9 ± 136.6 cm 2 , P = .211), few perforator numbers without pedicle manipulation, lack of intraoperative indocyanine green administration (75% vs. 25%, P = .607), and the use of superficial temporal vessels as recipient vessels., Conclusions: Scalp reconstruction using large ALT free flaps with the aid of imaging modalities facilitates the optimization of surgical techniques, such as pedicle manipulation, perforator numbers, and vein considerations, thereby contributing to successful reconstruction., (© 2024 Wiley Periodicals LLC.)

Background: The buccal fat pad (BFP) has previously been utilized for repair of various defects of the head and neck. Objectives: We explore the utility of a pedicled buccal fat advancement-transposition (BFAT) flap in various forms of midface reconstruction through a variety of surgical approaches and characterize its volume and axial reach in human anatomic specimens. Methods: Ten adult full-head human anatomic specimens were dissected, and a single surgical case demonstrating the use of a BFAT flap is described. Results: Nasolabial, subciliary, and deep plane facelift incisions all provided access to the BFP for use as a BFAT flap. The mean volume of mobilizable fat contained within a BFAT flap accessible through external incision was 7.1 cm 3 . Once fully mobilized, the externalized BFAT flap had a mean axial reach of 6.9 cm without tension. We also present a case illustrating the successful use of a BFAT flap for volumization of a large midface defect secondary to Mohs micrographic surgical resection of a cutaneous malignancy. Discussion: The BFAT flap, which exhibited substantial volume and reach in this study, can be harvested through multiple dissection windows or pre-existing defects and be used to reconstruct a variety of midface defects.

Background: The repair of facial skin and soft tissue defects remains a clinical challenge. The author introduced a novel "table tennis racquet" random skin flap for wound repair after facial skin cancer excision and discussed its survival mechanisms., Methods: A lateral mandibular neck skin flap shaped like a table tennis racquet with no well-known blood vessels at the narrow pedicle was designed in 31 cases to repair tissue defects. Among them, there were 8 cases of skin carcinoma in the frontotemporal area and 23 cases of skin carcinoma in the cheek. The flap area was 8.0 × 7.0 cm at maximum and 3.0 × 2.5 cm at minimum, with a pedicle width of 1.0-2.0 cm and a pedicle length of 2.0-6.0 cm., Results: All 31 "table tennis racquet" random skin flaps survived, although there were 3 cases with delayed healing of distal flap bruising. All of them had an ideal local shape after repair with a concealed donor area and inconspicuous scars., Conclusions: This flap has a "table tennis racquet" shape with a pedicle without well-known blood vessels and has a length-to-width ratio that exceeds that of conventional random flaps, making it unconventional. Because of its long and narrow pedicle, it not only has a large rotation and coverage area but also can be designed away from the defect area, avoiding the defect of no donor tissue being localized near the defect. Overall, this approach is an ideal option for repairing tissue defects after enlarged excision of facial skin carcinoma., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Treatment of scalp malignancies may include the need for craniectomy. The decision to perform cranioplasty is not straightforward and is frequently subjective. The purpose of this study was to assess the clinical outcomes after reconstruction of complex scalp and calvarial defects by comparing patients with and without cranioplasty., Methods: Retrospective review of the clinical records of a consecutive series of patients who underwent scalp soft tissue reconstruction after craniectomy for malignancy or osteoradionecrosis between 2014 and 2022 at Royal Melbourne Hospital was conducted. Demographics, previous treatments, surgical details, and post-operative complications were assessed. Traumatic injuries and decompressive craniectomies were excluded. Minimum follow-up of 6 months., Results: Thirty-seven patients were included in the study. Indications for surgery included skin malignancies, osteoradionecrosis, or both. There was one reconstructive failure (in the non-cranioplasty group). Infection and metalware exposure were common complications in patients who underwent cranioplasty (38.5%). No patient developed neurological symptoms subsequent to craniectomy. One patient needed revision surgery due to esthetic reasons (cranioplasty group). Transposition flaps were associated with more complications and revision procedures., Conclusion: Combined scalp and calvarial defects pose a difficult reconstructive challenge. Stable soft tissue coverage is more reliably achieved with free flap reconstruction. Cranioplasty is not always mandatory and should be reserved for cases with a very large bony defect or when the defect is located in a cosmetically sensitive area., Competing Interests: Declaration of Competing Interest None., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Scalp reconstruction has always been a challenging problem for even the most experienced surgeon to provide good aesthetic and functional results. This is mainly because the scalp is less mobile and tight, requiring a much larger dissection for the size of the original defect. We hypothesized that the omega variant perforator-based keystone island flap at the subgaleal plane provides a versatile and easily reproducible reconstructive option for scalp reconstruction after wide skin cancer excision. We reviewed all patients who underwent reconstruction with the keystone flap or its modification to repair scalp defects following wide resection of skin cancer in the scalp abutting calvarium from May 2021 to July 2023. We designed the flap width 50% wider than original keystone flap design first introduced by Dr. Behan. We reconstructed medium- to large-sized scalp defects ranging from 2×2 to 5×5 cm 2 using an omega variant perforator-based keystone island flap. All patients were satisfied with the aesthetic outcomes without complications. Keystone flaps are a versatile option for reconstructing the scalp after cancer resection. This strategy obviates the need for skin grafting, myocutaneous flap or free flap after cancer removal in the scalp., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

To reconstruct a large anterior skin and cartilage defect of the upper half of the external ear in an elderly patient after cancer surgery, different techniques are possible, but single-stage procedures should be advised. Combining flaps with reliable vascular supply, like the revolving door post-auricular flap and a mastoid advancement flap, is an attractive single-stage reconstructive option to rebuild a sturdy auricle., (© 2023 Australasian College of Dermatologists.)

Background: Scalp reconstruction requires knowledge of scalp anatomy and reconstructive options. Advances in the field have led to numerous procedures being at the disposal of the reconstructive surgeon, expanding treatment options for patients., Objective: To provide an algorithmic approach and general guidelines to consider when deciding on which scalp surgery will optimize cosmetic and functional outcomes., Methods & Materials: Previous literature was searched for the last 20 years to provide an updated guide., Results: Taking into consideration the location, size and local scalp anatomy of a presenting defect will lead to optimal surgical outcomes. Other confounding factors such as bone exposure and extremely large defects will affect decision making. An algorithmic approach has been provided in this review., Conclusion: While many reconstructive surgical options are available, the best ones will depend on individual presentation of scalp defects. Location and size are first line considerations while local scalp anatomy will allow for tailoring of reconstructive options. This will help to maximize cosmetic and aesthetic considerations., (© 2024. The Author(s).)

Competing Interests: Conflicts of interest None disclosed.

Background: Wide excision of malignant melanoma on the foot usually results in an extensive function-destroying defect, and the reconstruction of foot defects remains challenging for reconstructive surgeons. We propose using anterolateral thigh perforator (ALT) free flaps for the reconstruction of widespread defects caused by malignant melanoma in the sole., Methods: This retrospective study included 34 patients who underwent reconstruction of sole defects caused by malignant melanoma resection with 35 ALT perforator free flaps between August 2005 and July 2021., Results: In total, 18 male patients and 16 female patients were included (mean age at surgery, 65.4 years). The mean size of the flaps was 100.4 cm 2 . Thirty-three of the 35 flaps survived. Hematoma, seroma, and chronic ulceration were not identified in any cases. All patients achieved independent ambulation within the follow-up period, except 1 patient with gait discomfort. The 5-year overall and disease-free survival rates of patients were 64.4% and 56.6%, respectively., Conclusions: The ALT flap is a versatile surgical option that should be considered for reconstruction of the sole after malignant melanoma resection, considering its various surgical advantages and the functional aspects of independent ambulation, the aesthetic aspects of wearing conventional footwear, and the anatomical aspects of the sole., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Reconstructive procedures of the head, neck, and face after skin cancer resection are typically performed by surgeons trained in either ENT facial plastic surgery or plastic and reconstructive surgery. We analyzed a large national database to compare patient populations, practice, and outcomes of skin cancer reconstruction of the head, neck, and face performed by these 2 surgical specialties., Methods: Cases were selected from the American College of Surgeons National Surgical Quality Improvement Program. Variables that differed significantly on univariate analysis were included in a nominal logistic regression, with having at least 1 wound-specific complication, medical complication, or unplanned reoperation within 30 days as the dependent variables., Results: There were a total of 2850 cases, of which 61.36% were performed by ENT. Surgical specialty was not found to be a predictor of wound complications, medical complications, or unplanned reoperations. On multivariate analysis, operative times greater than 6 hours and anatomical location (specifically, skin cancer of the nose) predicted adverse outcomes. Significant differences were observed between the patient populations of the 2 specialties in terms of demographics, comorbidities, and the anatomical location of the cancer defect., Conclusion: Reconstruction of the head, neck, and face after skin cancer removal represents an important and common element in the scope of practice of both ENT facial plastic surgeons and plastic surgeons. No evidence was found to suggest that surgical specialty is associated with adverse postoperative outcomes. However, ENT facial plastic surgeons and plastic surgeons seem to manage unique patient populations and use different reconstructive techniques, reflecting their distinct training and areas of expertise. A multidisciplinary approach where the complementary skills of both specialties can be leveraged may optimize patient outcomes., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To analyze the clinical characteristics of scar cancer ulcer wound of head and face, and to investigate its diagnosis and treatment., Methods: The clinical data of 14 patients with head and facial scar cancer ulcer wounds who met the selection criteria and admitted between January 2021 and March 2022 were retrospectively analyzed. There were 8 males and 6 females. The age of onset ranged from 21 to 81 years with an average age of 61.6 years. The incubation period ranged from 1 month to 70 years, with a median of 4 years. Site of the disease included 7 cases of head, 6 cases of maxillofacial region, and 1 case of neck region. Injury factors included trauma in 5 cases, scratch in 5 cases, scalding in 2 cases, burn in 1 case, and needle puncture in 1 case. Pathological results showed squamous cell carcinoma in 9 cases, basal cell carcinoma in 3 cases, sebaceous adenocarcinoma in 1 case, papillary sweat duct cystadenoma combined with tubular apocrine sweat gland adenoma in 1 case. There was 1 case of simple extensive tumor resection, 1 case of extensive tumor resection and skin grafting repair, 7 cases of extensive tumor resection and local flap repair, and 5 cases of extensive tumor resection and free flap repair., Results: All the 14 patients were followed up 16-33 months (mean, 27.8 months). Two patients (14.29%) had scar cancer ulcer wound recurrence, of which 1 patient recurred at 2 years after 2 courses of postoperative chemotherapy, and was still alive after oral traditional Chinese medicine treatment. One patient relapsed at 1 year after operation and died after 2 courses of chemotherapy. One patient underwent extensive resection of the left eye and periocular tumor and the transfer and repair of the chimaeric muscle axial flap with the perforating branch of the descending branch of the left lateral circumflex femoral artery, but the incision healing was poor after operation, and healed well after anti-infection and debridement suture. The wounds of other patients with scar cancer ulcer did not recur, and the wounds healed well., Conclusion: Scar cancer ulcer wound of the head and face is common in the middle-aged and elderly male, and the main pathological type is squamous cell carcinoma. Local extensive resection, skin grafting, or flap transfer repair are the main treatment methods. Early active treatment of wounds after various injuries to avoid scar repeated rupture and infection is the foundamental prevention of scar cancer.

Objective: To investigate the efficacy of V-Y advancement flap with facial artery perforator for the repair of midface skin defects. Methods: A retrospective analysis was performed on 18 patients with facial skin cancer, including 11 males and 7 females, aged 65-83 years, who underwent the repair of midface skin defects using V-Y advancement flap with facial artery perforator in the Department of Head and Neck Surgery, Affiliated Cancer Hospital of Nantong University from January 2020 to April 2023. Medium, large or complex midface skin defects developed after surgical resections of the primary lesions. According to the defect site, size, location information of facial vessels, a V-Y advancement flap with appropriate shape was designed for each case. During the operation, the facial vessels and their perforators were retained in the pedicle of the flap, the facial nerve branches were dissected and protected, and the further denuded pedicle was determined according to actual amount of advancement. After the flap was advanced, the facial defect area was repaired without tension, and the anatomical positions and functions of the eyes, nose and mouth were restored as far as possible. Postoperative follow-ups were conducted to observe the survival rate of the flaps, postoperative complications, recurrences and metastases of tumors. Results: Midface defects of 3.0 cm×3.5 cm-6.5 cm×7.5 cm were observed after tumor resections, which involved one or more subregions. The sizes of the flaps were 3.5 cm×9.0 cm-7.0 cm×18.0 cm. All flaps were completely alive except for one with temporary local bruising. With following-up of 4-40 months, 5 of the 12 patients with lower eyelid and inner canthus invasions had lower eyelid ectropion, but no exposed keratitis was found; one case with poorly differentiated squamous cell carcinoma had lymph node metastasis in the submandibular region and underwent neck dissection again; no recurrence or metastasis occurred in the remaining cases. Conclusion: The V-Y advancement flap with facial artery perforator can be used to repair medium, large or complex midface skin defects, with a high survival rate, and the operation method is safe and reliable.

Introduction: Locally advanced non-melanoma skin cancer (NMSC) involving the periosteum or calvarium poses a clinical challenge for patients who are unfit for immunotherapy due to medical comorbidities and/or frailty. This case series aims to investigate outcomes for patients undergoing craniectomy and soft tissue reconstruction., Method: Patients who underwent craniectomy and soft tissue reconstruction for invasive NMSC with calvarium or periosteal invasion between 2016 and 2022 were included. Data, including demographics, operative details, and clinical outcomes, were gathered from Nottingham University Hospitals' digital health record and the histopathology electronic database., Result: Eight patients (average age: 78.4 years, 3 females 5 males) with significant comorbidities and varying degrees of periosteal or bone invasion fulfilled the inclusion criteria. Diagnoses included four squamous cell carcinomas, two basal cell carcinomas, and two pleomorphic dermal sarcomas. Five patients had a history of prior incomplete deep margin excision. The median sizes for soft tissue defect, tumor and bone defect size were 51.83 cm 2 , 34.63 cm 2 and 42.25 cm 2 , respectively. Intraoperative complications included one dural tear. Four patients underwent local flap reconstruction and with split-thickness skin grafting, four patients underwent free flap reconstruction. Adjuvant radiotherapy was administered to three patients. Complications comprised partial graft loss in two and complete graft loss in one. There was partial flap loss in one case. One patient required subsequent parotidectomy due to regional progression before achieving disease control. All patients achieved lasting locoregional disease control (average follow-up 29.7 months)., Conclusion: Craniectomy with soft tissue reconstruction proves to be a safe and effective treatment option in advanced NMSC of the scalp in patients unsuitable for immunotherapy due to frailty or medical co-morbidity., Competing Interests: Declaration of Competing Interest All authors have no conflicts of interests., (Copyright © 2024. Published by Elsevier Ltd.)

Various methods of reconstructing skin defects in the medial canthal region have been reported. We report 2 skin flaps for the upper and lower eyelids designed to reconstruct soft tissue defects in the medial canthal region based on the approach used for the orbit during surgeries for facial bone fractures. The skin flap was elevated without tension until it reached the defect. The skin flaps of the upper and lower eyelids were moved around the defect as rotational flaps and sutured. Two patients with skin defects in the medial canthal region after basal cell carcinoma resection were treated with this technique. No complications occurred, and good cosmetic and functional outcomes were obtained. This method can be used to reconstruct the eyelid with an elevated skin flap and is considered useful for repairing defects in the medial canthal region., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Summary: Basal cell carcinomas of the central anterior area of the auricle limited to the antihelix and scapha without peripheral infiltration of the helix are not uncommon. Resection is rarely transfixing, but resection of the underlying cartilage is often required. The complex anatomy of the ear and the lack of local tissue available makes its reparation challenging. Defects of antihelix and scapha require special reconstructive techniques, taking into account skin structure and the three-dimensional architecture of the ear. The reconstruction usually consists of full-thickness skin grafting or anterior transposition flap, requiring an extended skin resection. The authors describe a one-stage technique that uses a pedicled retroauricular skin flap turned over the anterior defect, followed by immediate closure of the donor site with a transposition or a bilobed retroauricular skin flap. The one-stage combined retroauricular flap reparation optimizes cosmetic outcome and reduces the risk of successive surgical procedures., (Copyright © 2023 by the American Society of Plastic Surgeons.)

Background: Large-defect reconstructive surgeries for skin cancer can be performed using different approaches. Integra Dermal Regeneration Template (DRT, Integra Life Sciences, Princeton, New Jersey, the United States) is a membrane utilized to fill skin defects, followed by second-stage surgery with a full-thickness skin graft or flap., Purpose: To evaluate the frequency of success of the single-stage scalp reconstructive surgeries using the DRT membrane without second-stage surgery and its feasibility in practice., Study Design, Setting, and Sample: This retrospective case series study was conducted to investigate the outcomes of patients with skin cancer scalp defects, reconstructed using DRT, from June 2019 to June 2022, in the Oral and Maxillofacial Department at Ashford and St. Peter's Hospitals, United Kingdom. The patients who underwent further surgery were excluded., Predictor Variable: Not applicable., Main Outcome: This study aimed to evaluate the achievement of complete re-epithelialization solely using the DRT membrane along with appropriate dressing management, scored as a "yes" or "no.", Covariates: Patient's age, defect size, timing of bolster, DRT silicone layer, and dressing removal; anticoagulation, antibiotics, complications, and appointments until complete healing., Analyses: Descriptive statistics were computed for each variable., Results: Forty patients were included in this study and 90% re-epithelialized without complications. Two cases of infection and three bleeding events were recorded. The mean patients' age was 81.5 ± 7.7 years, and the average defect size was 14.7 ± 10 cm 2 . The bolster and silicone layers were removed at 9.1 ± 3.2 and 29.2 ± 12.9 days, respectively. The average number of appointments until healing was 7.8 ± 4.8. Healing time was 3.8 ± 2.1 months, frequency of failure was 10, and 40% received antibiotics., Conclusions: In our experience, the DRT membrane can be used as a successful single-stage approach in minimizing the need for further surgery. Further studies are needed., (Crown Copyright © 2023. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Conflicts of interest None disclosed.

Background: Harvesting an adequate-sized flap is challenging for reconstructing large defects on the abdominal wall. A subtotal thigh flap would be one of the choices as it provides a well-vascularized large flap with muscle components. Moreover, dermatofibrosarcoma protuberans (DFSP) is a low-grade dermal neoplasm with a high recurrence rate. There is still no consensus on the extent of resection to prevent a recurrence., Objectives: We present a case of a patient who underwent the reconstruction of a large abdominal wall defect with a subtotal thigh flap after the resection of recurrent DFSP., Materials and Methods: A 59-year-old man killed from a recurrent huge mass in the lower abdomen with an invasion of the small intestine. His baseline characteristics and records of operations, medications, and outcomes were reviewed., Result: After tumor excision, a 28 × 30-cm subtotal thigh flap was harvested from his left thigh to reconstruct the abdominal defect. A microvascular anastomosis with left deep inferior epigastric vessels was made eventually. The flap was in good condition, and the donor site was covered with a split-thickness skin graft., Conclusions: Subtotal thigh flap may be considered for large abdominal wall defect reconstruction as it allows good perfusion of relatively large skin paddles compared with other free flaps. Also, patients with DFSP need definite margin-free resection and close follow-up to prevent a recurrence., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)