Reconstructing cancer defects of the cheek

Cheek reconstruction differs from eyelid reconstruction in a few important ways.  One the them is the presence of a large “named” vessel, the infraorbital artery.  The use of this vessel allows for a type of reconstruction that is not available in eyelid surgery.  The technique involved is called the “island pedicle flap”.

This patient below has a basal cell carcinoma of the right cheek:

The basal cell is located very near the region of the infraorbital artery.  This means that the reconstruction can involve wholesale incision and movement of a fairly large piece of tissue during the reconstruction, and it will have a good enough blood supply to survive and heal well.  The surgical plan was to use this island pedicle flap, as depicted below:

In the diagram, the blue circles are the anticipated defect in tissue.  The green triangle shows what will be incised (through skin and muscle), then lifted, to fill the blue circular defect.  By closing the incision inferiorly the proper way, this flap should heal in position and not cause problems with eyelid position.

The next photo shows the patient after the tumor has been removed, before the reconstruction:

One week after island pedicle flap repair, the patient is depicted below.  The triangular segment corresponds to the green triangle drawn in the previous picture, after is has been moved into the appropriate position.

Finally, after 6 months, the end result: