Case 1 (2023): Left Cheek Reconstruction with Combined VY- and Transposition Flap
Harald Welling, Michael Rose, Consultant, Roskilde Hospital, Denmark
Abstract
50-year old male presented to the dept. of Plastic Surgery in 2022 with a larger eroding tumour on the left cheek. The tumour had been present for several years. Recently, a new tumour had also started to form on the lateral portion of the left cheek. Biopsi revealed basal cell carcinoma, nodular subtype for both carcinomas.
BeforeAfter50-year old male presented to the dept. of Plastic Surgery in 2022 with a larger eroding tumour on the left cheek. The tumour had been present for several years. Recently, a new tumour had also started to form on the lateral portion of the left cheek. Biopsi revealed basal cell carcinoma, nodular subtype for both carcinomas.
Large BCC on the medial left cheek and a smaller BCC on the lateral portion of the cheek. Tumour demarcation and resection margins are marked.
2
The lateral tumour was excised first and closed primarily. The medial tumor was excised secondly, resecting deep subdermal structures including parts of the m. zygomaticus as well as nerve branches form n. infraorbicularis.
3
Flap design demarcated. First, the V-to-Y-flap was raised and sutured before the transposition flap was performed.
4
The predominant part of large medial defect was closed with an advancement V-to-Y-flap from the inferolateral portion of the cheek. Secondly, a transposition flap fromt the lateral zygomatic region of the cheek was raised to fully cover the superior part of the defect. The infraorbital dog ear that occured after flap inset was not corrected intraoperative so as not to compromise blood supply to the flap tip in a critical location where several flap tips met in the most medial portion of the cheek reconstruction.
5
Patient seen at suture removal 9 days postoperatively. Final suture removal was pushed back three days due to early signs of postoperative infection.
6Patient seen at 3 months postoperatively. The aesthetic result is pleasing to the patient, and ectropion did not occur. Another follow-up and 6 months postoperatively was planned to assess whether the infraorbital swelling from the non-resected dog-ear would diminish or if cosmetic correction will be warranted.
Frozen sections did not show any carcinoma in the intraoperativ frozen sections, and this was confirmed by final histopathology which revealed nodular and micronodular BCC with free resection margins.
How to cite this article
Harald Welling, Michael Rose, Consultant, Roskilde Hospital, Denmark. Case 1 (2023): Left Cheek Reconstruction with Combined VY- and Transposition Flap. Journal of Plastic, Breast & Reconstructive Surgery. 2023.
Open access. © 2023 The Author(s). Published by the Journal of Plastic, Breast & Reconstructive Surgery. Copyright to this case is shared between the author(s) and the journal; authors may reuse their own case for education, presentations and social media.
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