Of Facial Skin with Myocutaneous Free Flap

Larger defects of the facial skin are best repaired using a free tissue transfer where unlimited quantities of skin and soft tissue are available to repair the surgical defect. The disadvantage of free tissue transfer is that the color match often is not satisfactory and occasionally the tissue may be too bulky.

The patient shown in Figure 4-15A has a locally advanced, fungating squamous cell carcinoma of the preauricular region requiring wide excision, superficial parotidectomy and a neck dissection. A generous portion of the skin in the preauricular region was excised to encompass a three-dimensional resection in continuity with an ipsilateral comprehensive neck dissection (Figure 4-15B). The surgical defect thus created was repaired with a myocutaneous rectus abdominis flap. Postoperative appearance of the patient shows a satisfactory reconstruction of this large surgical defect, although the color match is not ideal (Figure 4-15C).

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Figure 4-15. A Locally advanced squamous cell carcinoma of the right preauricular skin showing extent of surgical excision outlined. B, The surgical specimen shows the extent of excision of the primary tumor en bloc with the contents of the right neck. C, The defect was reconstructed using a myocutaneous rectus abdominis flap—seen here 1 month after surgery.

Figure 4-15. A Locally advanced squamous cell carcinoma of the right preauricular skin showing extent of surgical excision outlined. B, The surgical specimen shows the extent of excision of the primary tumor en bloc with the contents of the right neck. C, The defect was reconstructed using a myocutaneous rectus abdominis flap—seen here 1 month after surgery.

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