Risk Stratification of Local Flaps and Skin Grafting in Skin Cancer-Related Facial Reconstruction: A Retrospective Single-Center Study of 607 Patients

Abstract

Background: Non-melanoma skin cancer (NMSC) takes up a substantial fraction of dermatological and plastic surgical outpatient visits and surgeries. NMSC develops as an accumulated exposure to UV light with the face most frequently diagnosed. Method: This retrospective study investigated the risk of complications in relation to full-thickness skin grafts (FTSG) or local flaps in 607 patients who underwent facial surgery and reconstruction at a high-volume center for facial cancer surgery at a tertiary university hospital. Results: Between 01.12.2017 and 30.11.2020, 304 patients received reconstructive flap surgery and 303 received FTSG following skin cancer removal in the face. Flap reconstruction was predominantly performed in the nasal region (78%, n = 237), whereas FTSG reconstruction was performed in the nasal (41,6%, n = 126), frontal (19.8%, n = 60), and temporal areas (19.8%, n = 60), respectively. Patients undergoing FTSGs had a significantly higher risk of hematoma (p = 0.003), partial necroses (p < 0.001), and total necroses (p < 0.001) compared to flap reconstruction. Age and sex increased the risk of major complications (hematoma, partial or total necrosis, wound dehiscence, or infection) for FTSG, revealing that men exhibited 3.72 times increased risk of major complications compared to women reconstructed with FTSG. A tumor size above 15 mm increased the risk of hematoma and necrosis significantly. In summary, local flaps for facial reconstruction after skin cancer provide lower complication rate compared with FTSGs, especially in elderly and/or male patients. The indication for FTSG should be considered critically if the patient’s tumor size and location allow for both procedures.

Full-Thickness Skin Graft from the Submental Triangle for Facial Defect Reconstruction

“…There was a total of 607 patients with facial skin defects who were treated with local flaps (304 patients) and skin grafts (303 patients). When evaluating infection and wound dehiscence, there was no significant difference between the two groups, but regarding hematoma and necrosis, they were significantly worse in the full-thickness skin graft group, possibly because they included larger skin defects for reconstruction in the full-thickness skin graft group [15]. Although the study stated that there was no significant difference in the surgical experience between the two groups, we believe that attentive hemostasis during the operation and the stable fixation of skin grafts can greatly reduce the complications of hematoma and necrosis.…”

“…Regarding postoperative complications, Mamsen et al discussed the differences between local flaps and full-thickness skin grafts in the reconstruction of facial defects [15]. There was a total of 607 patients with facial skin defects who were treated with local flaps (304 patients) and skin grafts (303 patients).…”

Melatonin/Sericin Wound Healing Patches: Implications for Melanoma Therapy

“…Therefore, it is essential to promote skin regeneration during melanoma treatment [170]. Throughout the years, various methods like autologous/allogenic skin grafts or tissue-engineered scaffolds were developed [171][172][173]. However, wound healing patches have drawn attention; understanding the requirements of melanoma treatment are indispensable to develop a strategy with integrated wound healing and therapeutic effects.…”

Salivary duct carcinoma of the parotid gland: a review article

“…Оптималните естетични резултати и възстановяването на функцията на лицевия нерв са ключовите компоненти за оценка на лечението. Опциите за затваряне на рани при дефицит на кожата или меките тъкани включват присаждане на кожа, цервико-фациално ламбо, трапецовидно ламбо, пекторално ламбо, делтопекторално ламбо и свободно микроваскуларно ламбо (27)(28)(29).…”