Shooting date : 2019-02-19
A 75-year-old patient operated on for Merkel cell carcinoma of the right cheek, T1N0M0, with sentinel lymph node biopsy followed by a reconstructive surgery using a large vertical advancement cervicofacial flap.
Step 1 : incision planning for monoblock removal of the skin tumor with 2 cm self margins and reconstructive surgery drawing from melolabial fold incision to cervical level of length equal to the height of the sbstance loss.
Step 2 : raising of the sub cutaneous flap from the cheek extended to the cervical area. The greater the size of the defect, the further the incision was extended to the cervical area.
Step 3 : identification and resection of sentinel node in level Ib was performed.
Step 4 : ascensioned flap was anchored with 2 layers to the infrorbital periosteal rim to avoid the risk of ectropion with tension-free cutaneous and subcutaneous sutures. Final neck closure was done with a V-Y plasty.
Reconstruction of large medial cheek skin defects.
General and local anaesthesia
1/ Hufschmidt K, Bozec A, Camuzard O, Clerico C, Berguiga R, Dassonville O, Santini J, Poissonnet G. Versatility of cervicofacial flaps: Cervical-medial cheek flap for reconstruction in cutaneous substance loss of the inner cheek. Head Neck. 2018;40(12):2574-2582.
2/Boyette JR, Vural E. Cervicofacial advancement-rotation flap in midface reconstruction : forward or reverse ? Otolaryngol Head Neck Surg. 2011;144(2):196-200.