Aesthetic Unit-Based Reconstruction of Facial Defects with Local Flaps after Surgical Excision of Basal Cell Carcinoma

Document Type : Research article

Author

The Department of Plastic Surgery, Faculty of Medicine, South Valley University

Abstract

Background: Basal cell carcinoma (BCC) represents the
most common type of facial skin cancer in Middle East and
Egypt. It rarely metastasizes, but because of its locally destructive
nature, it can cause high morbidity. Reconstruction
by local flap after surgical excision depends on the size of
the defect and the affected facial aesthetic unit.
Aim: To reveal the prevalence of facial BCC, relation of
its site to facial aesthetic units and type of local flaps used
for reconstruction per units.
Patients and Methods: A retrospective study was conducted
on 80 patients with facial BCC that admitted to the outpatient
clinic, Plastic Surgery Department, Qena University Hospital
from June 2018 to May 2020 (2 years duration). Only earlystage
and primary tumors were included. Statistical analysis:
Data was analyzed using the Statistical Package for Social
Sciences (SPSS) version 24. A p-value significant.
Results: 80 patients with facial basal cell carcinoma (BCC)
were collected from medical records. 45 (56.25%) patients
were males and 35 (43.75%) patients were females (M:F =
1.3:1). Ages ranged from 52-78 years old (SD = 65±13).
Nodular subtype was the most common clinical type of BCC
and presented in 45 (56.25%) patients. Nasal unit was the
most common site in 18 (22.5%) patients. The most random
flap applied was the rhomboid (Limberg) flap in 15 cases.
The most axial flap used was the nasolabial flap in 9 cases.
Complications (6 cases, 7.5%) included: Wound dehiscence
in 3 cases, infection in 2 cases and skin slough in 1 case. The
SCAR scale score result ranged from 0-2 score.
Conclusion: Facial defects reconstruction after surgery
for basal cell carcinoma is a complex endeavor that requires
careful consideration. There are many different local flaps
available depending on the particular facial subunit that
requires reconstruction. Careful recognition of the principles
of the facial subunits will equip the surgeon to achieve the
best possible functional and aesthetic outcomes.

Keywords

Main Subjects

References

Kang K.W., Lee D.L., Shin H.K., Jung G.Y., Lee J.H. and
Jeon M.S.: A Retrospective Clinical View of Basal Cell
Carcinoma and Squamous Cell Carcinoma in the Head
and Neck Region: A Single Institution's Experience of
247 Cases over 19 Years. Arch. Craniofac. Surg. Jun., 17
(2): 56-62, 2016.
2- Marzuka A.G and Book S.E.: Basal cell carcinoma: Pathogenesis,
epidemiology, clinical features, diagnosis, histopathology,
and management. Yale J. Biol. Med., Jun.
1; 88 (2): 167-79, 2015.
3- Welly Wijayanti and Khairuddin Djawad: Clinical study
of basal cell carcinoma on the face: A 5-year retrospective
study of 70 cases in a teaching hospital Surg Cosmet
Dermatol. Rio de Janeiro v.12 n.3 jul-set. p. 222-9, 2020.
Egypt, J. Plast. Reconstr. Surg., July 2021 131
4- Wu S., Han J., Vleugels R.A., Puett R., Laden F., Hunter
D.J. and Qureshi A.A.: Cumulative ultraviolet radiation
flux in adulthood and risk of incident skin cancers in
women. Br. J. Cancer, Apr. 2; 110 (7): 1855-61, 2014.
5- Hakverdi S., Balci D.D., Dogramaci C.A., Toprak S. and
Yaldiz M.: Retrospective analysis of basal cell carcinoma.
Indian J. Dermatol. Venereol. Leprol., Mar-Apr. 77 (2):
251, 2011.
6- Rivers J.K., Mistry B.D., Hung T., Vostretsova K. and
Mistry N.: A 13-Year Retrospective Study of Basal Cell
Carcinoma in a Canadian Dermatology Practice: A Comparison
Between Anatomical Location and Histopathologic
Subtypes. J. Cutan Med. Surg., May 20 (3): 233-40, 2016.
7- Smith V. and Walton S.: Treatment of facial Basal cell
carcinoma: A review. J. Skin Cancer, 1-7, 2011.
8- Hofer S.O. and Mureau M.A.: Improving outcomes in
aesthetic facial reconstruction. Clin. Plast. Surg., Jul. 36
(3): 345-54, 2009.
9- Rao J.K. and Shende K.S.: Overview of Local Flaps of
the Face for Reconstruction of Cutaneous Malignancies:
Single Institutional Experience of Seventy Cases. J. Cutan
Aesthet Surg., Oct-Dec. 9 (4): 220-25, 2016.
10- Choi J.H., Kim Y.J., Kim H., Nam S.H. and Choi Y.W.:
Distribution of Basal cell carcinoma and squamous cell
carcinoma by facial esthetic unit. Arch. Plast. Surg., Jul.
40 (4): 387-91, 2013.
11- Bertozzi N., Simonacci F., Greco M.P., Grignaffini E. and
Raposio E.: Single center evidence for the treatment of
basal cell carcinoma of the head and neck. Acta. Biomed.,
Jan. 22; 90 (1): 77-82, 2019.
12- Mancuso M., Gallo D., Leonardi S., Pierdomenico M.,
Pasquali E., De Stefano I., Rebessi S., Tanori M., Scambia
G., Di Majo V., Covelli V., Pazzaglia S. and Saran A.:
Modulation of basal and squamous cell carcinoma by
endogenous estrogen in mouse models of skin cancer.
Carcinogenesis, Feb. 30 (2): 340-7, 2009.
13- Cameron M.C., Lee E., Hibler B.P., Barker C.A., Mori
S., Cordova M., Nehal K.S. and Rossi A.M.: Basal cell
carcinoma: Epidemiology; pathophysiology; clinical and
histological subtypes; and disease associations. J. Am.
Acad. Dermatol., Feb. 80 (2): 303-317, 2019.
14- Betti R., Radaelli G., Bombonato C., Crosti C., Cerri A.
and Menni S.: Anatomic location of Basal cell carcinomas
may favor certain histologic subtypes. J. Cutan Med.
Surg., Nov-Dec. 14 (6): 298-302, 2010.
15- Janjua O.S. and Qureshi S.M.: Basal cell carcinoma of
the head and neck region: An analysis of 171 cases. J.
Skin Cancer, 2012: 943472, 2012.
16- Buettner P.G. and Raasch B.A.: Incidence rates of skin
cancer in Townsville, Australia. Int. J. Cancer, Nov. 23;
78 (5): 587-93, 1998.
17- Kim H.R., Na C.H., Shin B.S., et al.: A statistical study
of cutaneous basal cell carcinoma and squamous cell
carcinoma in Gwangju City and Chonnam Province (2006-
2010). Korean J. Dermatol., 49: 1073-8, 2011.
18- Helmy Y., A. Taha, Abd EL-Nasser Khallaf and Abd El-
Fattah Al-Sheikh: “Survival and aesthetic outcome of
local flaps used for reconstruction of face defects after
excision of skin malignancies: Multi-institutional experience
of 175 cases.” Int. J. Curr. Res. Med. Sci., 3 (5):
129-137, 2017.
19- Millard D.R.: Midline forehead skin flap. In: Berish S,
editor. Grabb’s Encyclopedia of Flaps. Vol. 1. Philadelphia,
PA, USA: Lippincott Williams & Wilkins, p. 99-100,
2009.
20- Bayer J., Schwarzmannová K., Dus˘ková M., Novotná K.,
Kníz˘e J. and Sukop A.: The nasolabial flap: The most
versatile method in facial reconstruction. Acta. Chir. Plast.
Spring, 59 (3-4): 135-141, 2018.
21- Furr M.C. and Wang T.D.: Complex local flap design in
cheek reconstruction. Oper. Tech. Otolaryngol. Head Neck
Surg., 22: 53-8, 2011.
22- Hayano S.M., Whipple K.M., Korn B.S. and Kikkawa
D.O.: Principles of Periocular Reconstruction following
Excision of Cutaneous Malignancy. J. Skin Cancer, 2012:
438502, 2012.
23- Egeler S.A., Johnson A.R., Ibrahim A.M.S., Bucknor A.,
Chen A., Malyar M., Tobias A.M., Lin S.J., Mureau
M.A.M. and Lee B.T.: Reconstruction of Mohs Defects
Located in the Head and Neck. J. Craniofac. Surg., Mar/
Apr. 30 (2): 412-417, 2019.
24- Russo F., Linares M., Iglesias M.E., Martínez-Amo J.L.,
Cabo F., Tercedor J., Costa-Vieira R., Toledo-Pastrana
T., Ródenas J.M. and Leis V.: Reconstruction Techniques
of Choice for the Facial Cosmetic Units. Actas Dermosifiliogr,
Oct. 108 (8): 729-737, 2017.
25- van Leeuwen A.C., The A., Moolenburgh S.E., de Haas
E.R. and Mureau M.A.: A Retrospective Review of Reconstructive
Options and Outcomes of 202 Cases Large
Facial Mohs Micrographic Surgical Defects, based on the
Aesthetic Unit Involved. J. Cutan Med. Surg., Nov-Dec.
19 (6): 580-7, 2015.
26- Helmy Ali Y., Farahat Mohamed A., Nasef M.A., Abu-
Elsoud A., Dahi A., Hossni M., Ouf M.O., Zayed T.,
ELBatawy A., Farid M., Taha Sayed A. and El-Banooby
T.: Facial skin cancer reconstructive and cosmetic outcomes:
Analysis with algorithm for its management. J.
Cosmet Dermatol., May 19 (5): 1182-1190, 2020.
27- Patel K.G. and Sykes J.M.: Concepts in local flap design
and classification. Operative Techniques in Otolaryngology
- Head and Neck Surgery, Mar. 22 (1): 13-23, 2011.
28- Garritano F. and Fedok F.: Facial reconstruction after
resection for cutaneous malignancies. Oper. Tech.
Otolaryngol., 24: 36-44, 2013.
29- Dzwierzynski and William M.D.: Aesthetic Facial Reconstruction
after Mohs Surgery, Plastic and Reconstructive
Surgery: Sept., Vol. 140 – Issu. 3 - p 643, 2017.
30- Nunez Castaneda J.M. and Chang Grozo S.L.: Facial
reconstruction according to aesthetic units. J. Cutan
Aesthet. Surg., 13: 298-304, 2020

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