The Rationale for Direct Linear Closure of Facial Mohsʼ Defects

Abstract

For many large defects, the simple method of direct linear closure often yields results superior to those of more time-consuming local flap options. Several dogmas of facial reconstruction are too unyielding, and the option of direct repair should not be overlooked. Traditional estimates of defect size requiring flap repair are incorrect; it is possible to close some large defects by direct approximation, with superior results.

Common Patterns of Reconstruction for Mohs Defects in the Head and Neck

“…28 Hierarchy of the reconstructive techniques for nasal defects (Table 1) and facial defects ( Table 2), according to size and location of the defects, may be used as a guideline or an algorithm to aid in reconstructing Mohs defects. Soliman et al 28 suggest that this method is often overlooked despite yielding superior results when compared with local flap options.…”

Long-term outcome of the cheek advancement flap, a report of 41 cases

“…This is why reconstruction of the cheek is a challenging task and needs thorough consideration in order to achieve the best functional and aesthetic restoration possible with minimal complications and distortion of the surrounding structures. In cases of large defects the local advancement flap is to be considered as one of the pliable reconstruction options [3,[8][9][10]15]. Most studies focus on early complications and other short-term outcome measures, with a wide range in follow-up [10,11,15].…”

“…One of the facial areas that can require reconstruction is the cheek area. While smaller defects can often be closed primarily, larger defects often require a local flap [2,3]. The cheek advancement flap is one of the workhorses in the reconstruction of larger defects in the cheek area.…”

Advances in nasal reconstruction

“…Soliman et al [11 ] performed a review of 1354 Moh's facial defects and their subsequent reconstructions to evaluate areas of the face in which primary closure had the best efficacy. In this review, primary closure was used least frequently (7%) in nasal defects in comparison to its use in other facial defects.…”