Lee Min Hak, Yi Changryul Claud, Kim Hoon Soo, Bae Yong Chan
Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Busan, Korea.
Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
Arch Craniofac Surg. 2025 Jun;26(3):109-114. doi: 10.7181/acfs.2024.0045. Epub 2025 Jun 20.
Free flaps, skin grafts, and local flaps are viable options for reconstructing large facial defects. When skin grafts, free flaps, or a single local flap are either not feasible or unlikely to yield satisfactory results, reconstruction can be performed using three or more local flaps. To evaluate the effectiveness of this surgical technique, this study analyzed the outcomes of reconstructions that utilized three or more local flaps.
This study included 10 patients who underwent facial reconstruction with three or more flaps following Mohs micrographic surgery (MMS) for skin cancer from 2016 to 2021. We investigated the types of flaps used, complications, and the recurrence rates of skin cancer. Patient satisfaction regarding color, contour, and scar was assessed through a questionnaire.
Of the 10 patients, nine underwent reconstruction with three flaps, while one patient required four flaps. There were no major complications such as flap loss. Partial necrosis occurred in one patient but was successfully managed with conservative treatment. There were no recurrences of the skin cancer that caused the initial defect, and overall patient satisfaction was high. Patients expressed high satisfaction with color, but lower satisfaction with contour and scar.
For large facial defects where free flaps or skin grafts would yield aesthetically or functionally inferior results, and reconstruction with a single flap is challenging, the application of three or more flaps has achieved good surgical outcomes. Utilizing three or more flaps can be considered a clinically useful method for reconstructing large facial defects.
游离皮瓣、皮肤移植和局部皮瓣是修复大面积面部缺损的可行选择。当皮肤移植、游离皮瓣或单个局部皮瓣不可行或不太可能产生满意结果时，可使用三个或更多局部皮瓣进行修复。为评估该手术技术的有效性，本研究分析了使用三个或更多局部皮瓣进行修复的结果。
本研究纳入了2016年至2021年期间因皮肤癌接受莫氏显微外科手术（MMS）后用三个或更多皮瓣进行面部修复的10例患者。我们调查了所使用皮瓣的类型、并发症以及皮肤癌的复发率。通过问卷调查评估患者对颜色、轮廓和瘢痕的满意度。
10例患者中，9例采用三个皮瓣进行修复，1例患者需要四个皮瓣。未发生皮瓣坏死等重大并发症。1例患者出现部分坏死，但经保守治疗成功处理。导致初始缺损的皮肤癌未复发，患者总体满意度较高。患者对颜色满意度较高，但对轮廓和瘢痕满意度较低。
对于游离皮瓣或皮肤移植在美学或功能上效果欠佳且单个皮瓣修复具有挑战性的大面积面部缺损，应用三个或更多皮瓣可取得良好的手术效果。使用三个或更多皮瓣可被视为修复大面积面部缺损的一种临床有用方法。
