Introduction: nature of the problem
There are numerous reconstructive options for cheek defects, such as primary closure, skin grafting, healing by secondary intention, and local, regional, or free flaps. The cervicofacial flap is the mainstay of reconstruction for medium- and large-sized cheek defects. It provides a large surface area with excellent color and texture match. A properly designed and elevated cervicofacial flap is an excellent and reliable choice to reconstruct cutaneous cheek defects.
The choice of flap depends on intrinsic wound characteristics, such as size, depth, and anatomic location, and extrinsic factors, such as adjacent anatomic structures and patient’s condition. The surgeon’s creativity plays an essential role in flap selection. In general, cheek defects are preferably reconstructed with tissue from adjacent units, such as the neck, submental area, or chest. The cervicofacial flap is an excellent choice for medium to large cheek defects.
Preparation and patient positioning
The patient is placed in the supine position. The head is rotated toward the contralateral side, and the neck is extended. The ipsilateral face and neck are prepared and draped in the sterile technique. It is important to have the entire ipsilateral face in the field to monitor any twitching during flap elevation. The eyes should be protected with an occlusive dressing or shield. The chest is included in the field if the plan is to use a cervicopectoral flap. General anesthesia is usually used for this flap; however, local anesthesia and sedation can be used. The use of paralytic agents during general anesthesia is not contraindicated when needed.
The resection is carried out in the standard oncologic technique. For an anteriorly based flap, the flap is marked from the lateral border of the defect, extended lateral to a preauricular crease, and carried inferiorly around the earlobe and then to a cervical crease ( Figs. 1 A and 2 A ).
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