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Thursday, January 12, 2006

Larger cutaneous defects of the face and cheek can be a particular challenge to reconstructive surgeons. By combining multiple surgical techniques in a planned multistage reconstruction, maximum scar camouflage can be achieved.

A 65-year-old man presented with a 22-mm defect of the left cheek following Mohs surgery (figure 1, A). Given the patient's age, the relaxed skin tension lines (RSTLs) of the face were easy to delineate (figure 1, B). The design of the initial reconstruction (figure 2) was based on two principles. First, a 30[degrees] elliptical excision and closure was designed along the axis of the RSTLs. Second, a geometric broken-line closure (GBLC) was designed into the tails of the excision.


Four weeks postoperatively, as scar contracture began, a small irregularity was seen along the inferior edge of the closure (figure 3, A). This was reexcised and closed during a minor procedure.


The patient was allowed to heal for 6 weeks, and then a left cheek dermabrasion was performed (figure 3, B). The final result was a very well-camouflaged scar, given the extent of the original defect (figure 4).


The result of combining multiple surgical modalities--in this case, an elliptical excision along the RSTLs, a GBLC, a small touch-up procedure, and dermabrasion--was a well-camouflaged scar, as well as a very pleased patient and surgeon.

From the Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City.

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