Reconstruction of Defects After Excision of Facial Skin Cancer Using a Venous Free Flap

Abstract

After extensive excision of skin cancer on the face, or when skin cancer is located on the 3-dimensional structures of the face, reconstruction with a local flap can be impossible, or clinicians are reluctant to reconstruct defects with a skin graft because of postoperative contraction, hyperpigmentation, or other complication. Instead, an arterialized venous free flap can be used as an alternative method of reconstruction to prevent distortion and recurrence. Eight patients underwent surgery with an arterialized venous-free flap. We evaluated the cosmetic results using ordinary scale methods on the basis of 4 categories (color, contour, texture, and distortion of surrounding structures) and recurrence and metastases of skin cancer physically. The follow-up period ranged between 24 and 48 months, with an average of 33 months. All of the soft-tissue defects made by excising the tumor were reconstructed with good outcomes, except for 1 case. Regarding the cosmetic evaluation, the color was fair, the contour and texture were good, absence of distortion of surrounding structures was excellent, and the overall results in most all cases were good. There were no recurrences or metastases during the follow-up period. The arterialized venous free flap is an alternative plan among several reconstruction methods when skin cancer on the face is extensively excised.

Head and Neck Reconstruction with Venous Flap: A Case Report

“… 4 The second publication in 2010 described a series of eight patients who received local excision of basal and squamous cell skin carcinomas and subsequent reconstruction with arterialized venous free flaps from the forearm. 3 In this report, the largest flap was noted to be a right temporal reconstruction using a 4 × 4 cm venous flap anastomosed to the superficial temporal artery and vein. To our knowledge, our 70 cm 2 flap describes the largest non-prefabricated arterialized venous free flap used for facial reconstruction and the first to incorporate shunt restriction in the flap design.…”

“…The largest flap size reported in their series was 20 cm 2 with two inflow vessels and one outflow, ultimately resulting in complete flap loss. 3 Our patient’s deficit was 70 cm 2 after appropriate cancer excision, and we utilized an arterialized free flap with one inflow and one outflow with no flap loss and good cosmetic outcome.…”

Pediatric nasal reconstruction with frontal flap: a case report

“…5 Local flaps are used in nasal reconstruction because they have similar appearance and dermal characteristics and are superior to skin grafts because of better integration given their vascular preservation. 6 For the reconstructive decision of the patient several factors were taken into account, mainly the affectation of several aesthetic units, the age of the patient, the presence of internal coverage and the integrity of the cartilaginous structure, as well as the unknown previous treatment, so opted for a frontonasal flap for its safe blood supply and similar skin characteristics. For an adequate technique, minimal manipulation of the tissue was performed with an adequate dissection and an identification of the pedicle, by means of the portable Doppler, authors could identify the supra trochlear artery in a simple way with the possibility of having a thin pedicle, promoting an adequate rotation and avoiding tissue swelling around the glabella allowing a primary closure of the most aesthetic donor site.…”

A Rare Axillary Cutaneous Squamous Cell Carcinoma: A Case Report and Literature Review

“…It is often necessary to perform reconstruction of the skin defect with a local flap or graft, but the latter offers worse results due to local depression and hyperpigmentation related to neighboring tissues, resulting in worse aesthetic results [10]. Radiotherapy can be indicated as adjuvant treatment after surgical excision in high-risk patients, with lymph node or perineural involvement [11].…”