[Reconstruction of facial skin defects by the V-Y subcutaneous pedicle flap]

Objective: To investigate the method and efficacy of reconstruction of facial skin defects after removing the lesions by applying the V-Y subcutaneous pedicle flap. Methods: A retrospective analysis was performed on 23 patients with facial reconstruction by using V-Y subcutaneous pedicle flap in the Otolaryngology Department of Guangdong Integrated Traditional Chinese and Western Medicine Hospital from March 2012 to April 2021. Patient ages ranged from 45 to 85 years old, with a mean age of 66.5 years (14 males and 9 females). The facial lesion sites included cheek in 12 cases (nearly lower eyelid in 4 cases), nose in 4 cases, lips in 3 cases, temporal in 2 cases and mental region in 2 cases. The initial pathology included malignant tumors (7 cases of basal cell carcinoma (BCC), 2 cases of squamous cell carcinoma(SCC), and 1 case of malignant melanoma) and benign lesions (7 cases of keratoderma, 3 cases of intradermal nevus, 1 case of pilomatricoma, 1 case of cutaneous mixed tumor and 1 case of epidermal cyst). The V-Y subcutaneous facial pedicled flaps were designed reasonably after the facial lesions were excised. The advantages of blood supply, survival rate and adverse events of the flap were analyzed Chi-square test was used to compare the observation results of different types of patients. Results: The primary focus of 23 patients was excised surgically, and intraoperative frozen-section examinations were performed for obtaining margins negative as far as possible. One positive margin was still found in 1 patient after multiple resection in our group. The defect sizes were 14 mm×12 mm-59 mm×54 mm. All the flaps survived. The adverse events were slight necrosis of the epidermis at the junction or vicinity of the three arms of "Y" shaped in 4 cases, but the wounds finally recovered by wet compress and dressing change. There were no significant differences in the incidences of adverse events between double and single pedicle flaps (4/19 vs. 0/4), between benign and malignant lesions (4/13 vs. 0/10), and between patients with and without underlying diseases (1/6 vs. 3/17) (χ² values were 0.98, 3.56, 0.01, respectively, all P>0.05). There were no other major complications such as dehiscence, hematoma, eyelid ectropion and lip deformation. The patients with benign lesions were followed-up at least for 3 months, while those with malignant tumors were followed-up for 6-36 months postoperatively, without recurrence. Conclusions: V-Y subcutaneous facial pedicled skin flap may be a "no-easy-necrotic" local flap in the repair of small and medium-sized facial defects.

[To reconstruct facial defects after removing skin lesions by using local flap]

Objective:The aim of this study is to investigate the method and effect of reconstruction of facial skin defects after removing the lesions by applying local flap. Method:Fifty-three patients （30 males and 23 females） with facial skin lesions. Complete surgical resection of the lesion; malignant tumor resection should be strictly non-tumor principle; intraoperative frozen section pathological examination confirmed negative margin; benign lesions can be cut off the lesion. According to the defect site, the appropriate local flap was used to repair the defect: 13 cases of modified VY propulsion flap, 8 cases of nasolabial flap, 8 cases of A/O-T shaped flap, 6 cases of rotating flap, 5 cases of direct sliding flap, multi-type There were 6 cases with flap, 2 cases with double leaf, 2 cases with prismatic flap and 3 cases with free flap. Result:Patients with malignant tumor were followed for 12-36 months postoperatively while followed for 10-12 months in the benign. Two patients with malignant tumor developed local recurrence and removed again. At half a year after first resection. Distal partial necrosis occurred in 5 cases while the wound dehiscence in1case, others were well developed. No others major complications occurred. Conclusion:There are various types of local skin flap for repairing facial skin defects. It is very important to excise the primary lesion radically before reconstruction,the satisfactory curative effect can be obtained through reasonable design of the flap.

[The clinical features and surgical treatment of facial basal cell carcinoma]

Objective:To investigate the clinical features and reasonable surgical treatment of facial basal cell carcinoma (BCC). Method:The clinical features of primary facial BCC from 37 patients were analyzed.All patients were cured by standard surgical excision with intraoperative frozen section examination and ensuring margins negative,the defects were reconstructed by using adaptive flaps after resection. Result:The patients were followed up for 12 to 36 months after operation.Two cases of 37(2/37,5.41%) with unclear margin developed local recurrence during 4-6 months after resection,the cure rate was 94.59% (35/37). Except 4 cases were suffered with distal skin flap necrosis, the others were well developed. Conclusion:The clinical feature of primary facial basal cell carcinoma was various. The complete resection of primary nidus with clear margin is the key to a successful treatment of facial basal cell carcinoma, and satisfactory therapeutic effects can be obtained after repairing defects by using adaptive flaps after resection.