Reconstruction of complex facial defects after radical resection of advanced skin cancers

The surgical management of patients with extensive facial skin cancers is challenging and involves a multidisciplinary team of specialists that includes an otolaryngologist, an oncologist, a pathologist, a neurosurgeon, an oculoplastic surgeon, and a plastic and reconstructive surgeon [1,2]. Skin cancers are typically seen at a stage during which a variety of therapies are effective [3]. In situations in which the tumor is highly aggressive and the patient neglectful, skin cancers can invade important facial structures and reach enormous size. The recent advances in surgical technique have allowed these operations to be performed at specialized centers. The postresection defect may result in exposure of vital structures and a devastating functional and cosmetic deformity if it is not reconstructed immediately. The immediate reconstruction of these postablative defects is necessary not only for the survival of the patient but for the patient's overall functional restoration and return to normal daily activities. Although local flaps have been used in select cases, the most versatile technique for management of these wounds is microvascular soft tissue transfer, which provides reliable vascularized tissue coverage for exposed structures such as the brain, globe, and neurovascular tissues [2,4-10]. In this article we present our experience with reconstruction of these defects.