Reconstructive approaches for facial defects following basal cell carcinoma excision

Abstract

Basal cell carcinoma (BCC) is the most common skin cancer, often affecting sun-exposed areas of the face. Although it rarely metastasizes, its excision can leave significant defects, requiring careful reconstruction to restore both function and aesthetics of the facial area. This study evaluates reconstructive methods, including primary closure, skin grafts, and local flaps, focusing on their indications and outcomes. The complex anatomy of the face necessitates careful consideration when selecting a reconstruction method after BCC excision. The choice depends on defect size, location, and depth. Primary closure ir a surgical method suitable for small defects and involves directly suturing the wound edges. This method is limited to areas with sufficient skin laxity and typically results in minimal scarring. Skin grafts are employed for larger defects, as this technique involves transplanting skin from a donor site to the excision site. While effective for coverage, potential drawbacks include color mismatch and textural differences, which may affect aesthetic outcomes. For substantial or aesthetically sensitive areas, local flaps—such as rotation, advancement, or transposition flaps—are preferred. These techniques utilize adjacent tissue with similar color and texture, enhancing cosmetic and functional results. The paramedian forehead flap and nasolabial flap are commonly used for central facial defects, offering reliable vascularity and tissue compatibility. Reconstruction near critical areas like the nose, eyes, or mouth requires function-preserving techniques. Local flaps provide superior aesthetic and functional results, but staged procedures may be necessary. Despite advancements, complications such as flap failure, wound dehiscence, and scarring remain concerns, emphasizing the importance of precise surgical execution and preoperative planning. Factors such as patient health, skin condition, and defect complexity influence the selection of the best reconstructive method. A personalized approach to BCC defect reconstruction optimizes both cosmetic and functional outcomes. While primary closure suffices for small defects, local flaps are essential for larger, complex cases requiring structural support and aesthetic preservation. Continuous innovation in reconstructive techniques is necessary to enhance patient satisfaction, long-term healing, and surgical precision.