Simplifying cheek reconstruction: A review of over 400 cases

Background: The cheek is a vast, well-vascularized facial subunit defined by the preauricular crease laterally, the mandible inferiorly, the lips and nasolabial fold medially, and the orbit-cheek crease and zygomatic arch superiorly. Reconstruction of the cheek commonly takes advantage of skin laxity in older patients and the relaxed skin tension lines of the face. Poor reconstructive techniques can cause or exacerbate significant deformities, especially in the oral and ocular regions. Methods: Four hundred twenty-two cases of post-Mohs cheek reconstruction were reviewed retrospectively. All cases were performed sequentially over 10 years by the senior author (J.F.T.). Indications, techniques, postoperative care, complications, and patient characteristics (e.g., age, sex, medical history, defect size, and skin quality) were taken into consideration for each case. Results: The procedures used for cheek reconstruction included direct closure (53 percent), cervicofacial advancement flaps (19 percent), perialar crescentic advancement flaps (8 percent), full-thickness skin grafting (8 percent), V-Y advancement flaps (2 percent), and free flaps (1 percent). Although no attempt was made to modify patients' anticoagulation status before surgery, no hematomas were reported. Nine patients had multiple procedures for cancer recurrence or new defects, and all but four operations were performed at a university hospital outpatient surgery center. Seventeen total complications were noted from distal flap necrosis (n = 2), ectropion (n = 7), wound healing (n = 7), and compromised vascular supply (n = 1). Conclusion: Knowledge of aesthetic considerations and appropriate use of operative techniques yield optimum cheek reconstruction defined by successful wound closure, thoughtful scar placement, and minimal postoperative complications.