Skin defects resulting from surgical excision of lesions involving the skin in the infraorbital region and medial part of the cheek are best suited for repair using a Mustarde flap. The major blood supply of this skin flap is from the posterior branches of the facial artery with the wide pedicle of the flap remaining inferiorly.
A patient with a Hutchinson's melanotic freckle (lentigo maligna or in situ melanoma) presenting on the skin of the cheek in the right infraorbital region is shown in Figure 4-12A. The superior margin of the surgical defect and the Mustarde flap are kept as close to the tarsal margin as possible, depending on the location of the lesion and the surgical defect. In this particular patient, the medial border of the defect was aligned to the nasolabial skin crease. The extent of surgical resection depends on the surface dimension, depth, and histology of the primary tumor.
Excision of the tumor is completed, preserving the orbicularis oculi and its nerve supply but carefully excising a generous margin of underlying fat (Figure
4-12B). Skin incision is completed for elevation of the Mustarde flap (Figure 4—12C) and the flap is rotated anteromedially to cover the surgical defect.
The postoperative appearance of the patient approximately 3 months later shows an acceptable esthetic result achieved by this technique (Figure 4-12D).
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