Reconstructive Options for the Face

  • Ashlin J. Alexander
  • Sinclair M. Gore
  • Jonathan Clark
Part of the Head and Neck Cancer Clinics book series (HNCC)


Non-melanoma skin cancer (NMSC) is the most common form of cancer worldwide. In 2008, approximately 430,000 cases of NMSC were diagnosed in Australia; of these, 296,000 were basal cell carcinoma (BCC) and 138,000 were squamous cell carcinoma (SCC) [1, 2]. Whereas many treatment options exist, the mainstay of management is surgical excision with adequate margins, followed by reconstruction. The functional and aesthetic consequences of surgery of the face, more than that of any other part of the body, can be dramatic. Therefore, the reconstructive surgeon must apply a thorough and thoughtful approach to the repair of facial defects. While a full analysis of the topic is outside the scope of this chapter, an overview of the general concepts and techniques used to address the various subunits of the face are discussed.


Advancement Flap Rotation Flap Transposition Flap Tarsal Plate Nasal Defect 
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  1. 1.
    Australian Institute of Health and Welfare and Australasian Association of Cancer Registries. Cancer in Australia: an overview, 2008. Cat. no. CAN 32. Canberra: AIHW; 2008.Google Scholar
  2. 2.
    Australian Institute of Health and Welfare and Cancer Australia. Non-melanoma skin cancer: General practice consultations, hospitalization and mortality. Cancer series no. 43. Cat. no. 39. Canberra: AIHW; 2008.Google Scholar
  3. 3.
    Raposio E, Santi P, Nordstrom RE. Effects of galeotomies on scalp flaps. Ann Plast Surg. 1998;41:17–21.CrossRefPubMedGoogle Scholar
  4. 4.
    Ahuja RB. Geometric consideration in the design of rotational flaps in the scalp and forehead region. Plast Reconstr Surg. 1988;81:900–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Terkonda RP, Sykes JM. Concepts in scalp and forehead reconstruction. Otolaryngol Clin N Am. 1997;30:519–39.Google Scholar
  6. 6.
    Beasley NJ, Gilbert RW, Gullane PJ, et al. Scalp and forehead reconstruction using free revascularized tissue transfer. Arch Facial Plast Surg. 2004;6:16–20.CrossRefPubMedGoogle Scholar
  7. 7.
    Ch’ng S, Clark JR. The scapular angle adds versatility to the latissimus dorsi free flap in complicated scalp reconstruction. J Plast Reconstr Aesthet Surg. 2011;64:e248–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Konior RJ, Kridel RWH. Tissue expansion in scalp surgery. Fac Plast Surg Clin N Am. 1994;2:203.Google Scholar
  9. 9.
    Baker SR, Swanson NA. Clinical applications of tissue expansion in head and neck surgery. Laryngoscope. 1990;10:313–9.Google Scholar
  10. 10.
    Cook TA, Israel JM, Wang TD, et al. Cervical rotation flaps for midface resurfacing. Arch Otolaryngol Head Neck Surg. 1991;117:77–82.CrossRefPubMedGoogle Scholar
  11. 11.
    Ch’ng S, Ashford BG, Gao K, et al. Reconstruction of post-radical parotidectomy defects. Plast Reconstr Surg. 2012;129:275e–87e.Google Scholar
  12. 12.
    Pribaz JJ, Meara JG, Wright S, et al. Lip and vermilion reconstruction with the facial artery musculomucosal flap. Plast Reconstr Surg. 2000;105:864–72.CrossRefPubMedGoogle Scholar
  13. 13.
    Burget GC, Menick FJ. Aesthetic restoration of one-half the upper lip. Plast Reconstr Surg. 1986;78:583–93.CrossRefPubMedGoogle Scholar
  14. 14.
    Webster RC, Coffey RJ, Kelleher RE. Total and partial reconstruction of the lower lip with innervated muscle-bearing flaps. Plast Reconstr Surg. 1960;25:360–71.CrossRefGoogle Scholar
  15. 15.
    Carroll CM, Pathak I, Irish J, et al. Reconstruction of total lower lip and chin defects using the composite radial forearm-palmaris longus tendon free flap. Arch Facial Plast Surg. 2000;2:53–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Fujimori R. ‘Gate flap’ for the total reconstruction of the lower lip. Br J Plast Surg. 1980;33:340–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Chang KP, Lai CS, Tsai CC, et al. Total upper lip reconstruction with a free temporal scalp flap: long term follow up. Head Neck. 2003;25:602–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Robotti E, Righi B, Carminati M, et al. Oral commissure reconstruction with orbicularis oris elastic musculomucosal flaps. J Plast Reconstr Aesthet Surg. 2010;63:431–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Goldstein MH. The elastic flap for lip repair. Plast Reconstr Surg. 1990;85:446–52.CrossRefPubMedGoogle Scholar
  20. 20.
    Zide BM. Anatomy of the eyelids. Clin Plast Surg. 1981;8:623–34.PubMedGoogle Scholar
  21. 21.
    Baker S. Local flaps in facial reconstruction. 2nd ed. Philadelphia: Elsevier Inc; 2007.Google Scholar
  22. 22.
    Tenzel RR, Stewart WB. Eyelid reconstruction by the semicircular flap technique. Ophthalmology. 1978;85:1164–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Hughes WL. A new method for rebuilding a lower lid. Arch Ophthalmol. 1937;17:1008.CrossRefGoogle Scholar
  24. 24.
    Uchinuma E, Sakurai H, Shioya N. Anterofrontal superficial temporal artery island flap for full-thickness eyelid reconstruction. Ann Plast Surg. 1989;23:433–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Cutler NL, Beard C. A method for partial and total upper lid reconstruction. Am J Ophthalmol. 1955;39:1–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Burget GC, Menick FJ. The subunit principle for nasal reconstruction. Plast Reconstr Surg. 1985;76:239–47.CrossRefPubMedGoogle Scholar
  27. 27.
    Burget GC, Menick FJ. Nasal support and lining: the marriage of beauty and blood supply. Plast Reconstr Surg. 1989;84:189–202.CrossRefPubMedGoogle Scholar
  28. 28.
    Fliss DM, Freeman JL. The nasal glabellar flap. J Otolaryngol. 1994;23:6–7.PubMedGoogle Scholar
  29. 29.
    Ebrahimi A, Nejadsarvari N, Koushki ES. Application of modified rintalaflap in nasal tip reconstruction. Am J Otolaryngol. 2012;33:685–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Washio H. Retroauricular-temporal flap. Plast Reconstr Surg. 1969;43:162–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Parkhouse N, Evans D. Reconstruction of the ala of the nose using a composite free flap from the pinna. Br J Plast Surg. 1985;38:306–13.CrossRefPubMedGoogle Scholar
  32. 32.
    Menick FJ. A 10-year experience in nasal reconstruction with the three-stage forehead flap. Plast Reconstr Surg. 2002;109:1839–55.CrossRefPubMedGoogle Scholar
  33. 33.
    Zitelli JA. The bilobed flap for nasal reconstruction. Arch Dermatol. 1989;125:957–9.CrossRefPubMedGoogle Scholar

Copyright information

© Faruque Riffat, Carsten E. Palme, Michael Veness, Rehan Kazi, Raghav C. Dwivedi 2015

Authors and Affiliations

  • Ashlin J. Alexander
    • 1
  • Sinclair M. Gore
    • 2
  • Jonathan Clark
    • 3
  1. 1.Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck SurgeryUniversity of Toronto, Mount Sinai Hospital and Rouge Valley HospitalTorontoCanada
  2. 2.Plastic and Reconstructive SurgeryOxford University HospitalsOxfordUK
  3. 3.Head and Neck SurgerySydney Head and Neck Cancer Institute, Royal Prince Alfred HospitalSydneyAustralia

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