Reconstruction after cutaneous malignancy

Question 1

What is the appropriate management of a 1-cm skin only central cheek defect?

Answer 1

Primary closure

Question 2

What is the appropriate management of a 2- to 4-

cm skin only central cheek defect?

Answer 2

Local flap

Question 3

What is the appropriate management of a > 4 cm skin-only central cheek defect?

Answer 3

Facial or cervicofacial rotation flap

Question 4

What is the appropriate closure of a skin only

defect of less than half the lip (orbicularis intact)?

Answer 4

Primary closure

Question 5

What is the appropriate closure of a full thickness
defect of half to two-thirds of the lip (commissure
intact)?

Answer 5

Abbe-Estlander flap

Question 6

What is the appropriate closure of a full-thickness
defect of one-half to two-thirds of the lip involving
the commissure?

Answer 6

Karapandzic flap

Question 7

What is the appropriate closure of a full thickness

defect involving greater than two-thirds of the lip?

Answer 7

Radial forearm free flap with palmaris tendon or anterior

lateral thigh and fascia lata flap

Question 8

What is the vascular supply for the paramedian

forehead flap used in nasal reconstruction?

Answer 8

Supratrochlear artery and vein

Question 9

What components of the nose must be considered

during reconstruction?

Answer 9

Skin, cartilage, bone, and mucosal lining. Failure to
reconstruct each of these elements will lead to poor
cosmetic and functional results.

Question 10

What is the aesthetic subunit principle of nasal

reconstruction?

Answer 10

The nose is made up of nine subunits: the dorsum, tip and
columella, paired lateral sidewalls, ala, and soft tissue
triangles. The best cosmetic result can be achieved when
these are reconstructed separately, and when greater than
half of a subunit is resected, resection of the remainder of
the subunit is desirable for cosmesis.

Question 11

What local flap is most commonly used for nasal
sidewall defects when primary closure is not
achievable?

Answer 11

Bilobed flap

Question 12

What is the general reconstructive ladder for full

thickness lower eyelid defects?

Answer 12

● < 30%: Primary closure, with or without lateral canthol-
ysis, for larger defects

● 30 to 50%: Semicircular flap with or without periosteum
● > 50%: Tarsoconjunctival flap with flap or graft closure of
the skin

Question 13

What is a Tenzel flap?

Answer 13

Periorbital semicircular advancement flap for eyelid recon-

struction

Question 14

What is a Hughes flap?

Answer 14

A pedicled tarsoconjunctival flap used in reconstruction of large (> 50 to 60%) full-thickness eyelid defects

Question 15

What are limiting factors in using split-thickness

skin grafts in scalp reconstruction?

Answer 15

● They require a vascular bed; if periosteum is absent, must drill to bleeding bone or rotate vascular tissue (periosteum, temporalis) into defect
● Poor color, texture, thickness, and hair match
● If postoperative radiation is required, a split-thickness
skin graft on bone will very likely undergo necrosis.

Question 16

What is the flap of choice for large (> 100 cm2)

scalp defects

Answer 16

Latissimus dorsi myocutaneous free flap with split-thickness

skin graft