Principles and Clinical Application of Free-Style Capillary Perforator-Based Flap for Coverage of Facial Skin Cancer Defects

Abstract

This study introduces a free-style perforator based island flap (PBIF) for the reconstruction of skin defects. From March 2012 to December 2022, a retrospective investigation was conducted on patients who underwent reconstruction for facial defects due to skin cancer. Data on the patients' gender, age, anesthesia method, diagnosis, defect location, flap size, complications, and follow-up periods were collected. There are several principles for designing the PBIF: finger-pinching method, alignment with the direction of wrinkles, the smaller width and longer length of the flap, and proximal attachment to the muscle. A total of 32 patients were included, with an average age of 63.6 years. Surgeries were performed in various regions, such as the infraorbital area, nose, cheek, philtrum, and the anterior/posterior/inferior auricular regions, with an average flap size of 7.63 cm². There were no complications, such as venous congestion or vascular insufficiency in the skin flaps, although one case required revisional closure due to flap disruption. The PBIF is a useful and effective method for the restoration of facial defects. This method can provide simple yet aesthetically satisfying results, showing stable outcomes without complex surgeries or complications. This study indicates the potential for this method to be more widely employed in reconstructive surgeries in the future.

Keywords: basal cell carcinoma; local flap; skin cancer; squamous cell carcinoma; surgery.

Figure 1

(a) A 76-year-old male with squamous cell carcinoma on left medial canthal area. (b) A 1 × 1.5 cm sized defect was shown after excision and a 1.5 × 3.5 cm sized flap was designed along the angular artery in the supra-labial fold. (c) The flap was raised with 160-degrees rotation for avoiding significant scarring. (d) Immediate postoperative view. (e) The outcome showed no complication.

Figure 2

(a) A 67-year-old female presented with basal cell carcinoma on nasal area. (b) A 3 × 2 cm sized defect was shown after basal cell carcinoma excision. (c) A 3 × 1 cm sized free style perforator island flap was designed. (d) The flap was raised with a rotation angle of approximately 90 degrees, and mobilized to the defect area. (e) Immediate postoperative view. (f)The outcome showed no evidence of reconstruction or hypertrophic scarring.

Figure 3

(a) A 62-year old female with basal cell carcinoma on left cheek. (b) A 1.5 × 1.5 cm sized defect was shown after basal cell carcinoma excision and a 3 × 1.5 cm sized free style perforator flap was designed. (c) The flap was raised with rotation within 90 degrees of the defect, parallel to the axis of the eye. (d) The outcome showed no complications including ectropion.