DOI QR코드

DOI QR Code

Comparison of local flaps versus skin grafts as reconstruction methods for defects in the medial canthal region

  • Min Hak Lee (Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine) ;
  • Hoon Soo Kim (Biomedical Research Institute, Pusan National University Hospital) ;
  • Yong Chan Bae (Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine)
  • Received : 2024.05.05
  • Accepted : 2024.06.11
  • Published : 2024.06.20

Abstract

Background: The medial canthal region features a complex three-dimensional and internal anatomical structure. When reconstructing a defect in this area, it is crucial to consider both functional and aesthetic aspects, which presents significant challenges. Generally, local flaps are preferred for reconstruction; however, skin grafts can be used when local flaps are not feasible. Therefore, we conducted a comparative analysis of surgical outcomes skin grafts when local flaps were not feasible, to determine which surgical method is more effective for medial canthal region reconstruction. Methods: Twenty-five patients who underwent medial canthal region reconstruction using skin grafts or local flaps from 2002 to 2021 were enrolled. Patient information was obtained from medical records. Five plastic surgeons evaluated the surgical outcomes based on general appearance, color, contour, and symmetry. Results: Skin grafts were used in eight patients and local flaps were used in 13. Combined reconstructions were employed in four cases. Minor complications arose in four cases but improved with conservative treatment. No major complications were reported. Recurrence of the skin cancer was noted in two cases. All categories showed higher scores for the local flap compared to both skin graft and combined reconstruction; however, the differences were not statistically significant respectively. Conclusion: The choice of appropriate surgical methods for reconstructing defects in the medial canthal region depends on various factors, including the patient's overall health, the size and depth of the defect, and the degree of involvement of surrounding structures. When a local flap is not feasible, a skin graft may provide favorable surgical outcomes. Therefore, a skin graft can serve as a viable alternative for reconstructing the medial canthal region.

Keywords

Acknowledgement

The author would like to thank Dr. Joo Hyoung Kim, Dr. Seong Hwan Bae, Dr. Hyung Joon Seo, Dr. Changryul Claud Yi, and Dr. Ryuck Seong Kim for their assistance in evaluating the surgical outcomes based on general appearance, color, contour, and symmetry.

References

  1. Ogino A, Onishi K, Okada E, Nakamichi M. Medial canthal reconstruction with multiple local flaps. JPRAS Open 2017;15:4-9.  https://doi.org/10.1016/j.jpra.2017.08.007
  2. Czyz CN, Cahill KV, Foster JA, Michels KS, Clark CM, Rich NE. Reconstructive options for the medial canthus and eyelids following tumor excision. Saudi J Ophthalmol 2011;25:67-74.  https://doi.org/10.1016/j.sjopt.2010.10.009
  3. Bostwick J 3rd, Vasconez LO, Jurkiewicz MJ. Basal cell carcinoma of the medial canthal area. Plast Reconstr Surg 1975;55:667-76.  https://doi.org/10.1097/00006534-197506000-00004
  4. Vogelin E, deRoche R, Luscher NJ. Reconstruction of the medial canthus: full-thickness skin graft or local flap? Eur J Plast Surg 1994;17:94-7.  https://doi.org/10.1007/BF00176924
  5. Parker AM, Richardson MA, Jordan JR. Functional reconstruction of large medial canthal defects. Facial Plast Surg 2014;30:656-60.  https://doi.org/10.1055/s-0034-1396525
  6. Pierazzi DM, Arleo S, Faini G. Reconstruction of medial canthal region with orbicularis oculi myocutaneous flap: our experience. JPRAS Open 2023;37:171-4.  https://doi.org/10.1016/j.jpra.2023.07.006
  7. Han J, Kwon ST, Kim SW, Jeong EC. Medial and lateral canthal reconstruction with an orbicularis oculi myocutaneous island flap. Arch Plast Surg 2015;42:40-5.  https://doi.org/10.5999/aps.2015.42.1.40
  8. Kim JH, Kim JM, Park JW, Hwang JH, Kim KS, Lee SY. Reconstruction of the medial canthus using an ipsilateral paramedian forehead flap. Arch Plast Surg 2013;40:742-7.  https://doi.org/10.5999/aps.2013.40.6.742
  9. Kim RS, Yi C, Kim HS, Jeong HY, Bae YC. Reconstruction of large facial defects using a combination of forehead flap and other procedures. Arch Craniofac Surg 2022;23:17-22.  https://doi.org/10.7181/acfs.2021.00381
  10. Wollina U. Reconstruction of large facial defects after delayed Mohs surgery for skin cancer. Acta Dermatovenerol Croat 2015;23:265-9. 
  11. Motomura H, Taniguchi T, Harada T, Muraoka M. A combined flap reconstruction for full-thickness defects of the medial canthal region. J Plast Reconstr Aesthet Surg 2006;59:747-51.  https://doi.org/10.1016/j.bjps.2005.11.017
  12. Kang JK, Lee JS, Yun BM, Shin MS. Usefulness of full-thickness skin grafting from the infraclavicular area for facial reconstruction. Arch Craniofac Surg 2020;21:357-62.  https://doi.org/10.7181/acfs.2020.00479
  13. Kim YS, Park JJ, Yi HS, Park JH, Kim HI. Is the retroauricular region a suitable donor site for full-thickness skin grafting in the era of mask wearing? Arch Craniofac Surg 2023;24:66-72. https://doi.org/10.7181/acfs.2023.00164