Indications for facial flaps

Authors: Liv Schöllhammer, MD, Frederik Gulmark Hansen, med.stud. and Magnus Balslev Avnstorp, MD

Here you will learn about the Indications and contraindications for performing af facial flap.

Indications

A facial flap may be indicated in the following scenarios:

• Defect cannot be closed directly: The defect is too large or complex for direct closure without excessive tension.

• Secondary healing would cause significant scarring: Healing by secondary intention is likely to result in unintentional scarring that negatively affects physical appearance.

• Skin grafts are unsuitable: A graft may result in poor aesthetic outcomes, such as mismatched color, strictures, or functional issues (e.g., drag in the nose, lips, or eyelids).

• Donor site can be closed with minimal impact: The donor site can be closed directly without causing significant physical or aesthetic concerns.

• Flap is reliable for reconstruction: The flap is deemed reliable based on the surgeon’s expertise and the anatomy of the defect.

• Like-for-like replacement: The flap closely matches the defect in skin color, texture, and thickness, ensuring a more natural and aesthetically pleasing result.

Contraindications

Performing a facial flap may be contraindicated in the following situations:

• Direct closure is possible: If the defect can be closed directly with good expected results, a flap may not be necessary.

• Skin carcinoma is better treated with radiotherapy: Certain lesions, such as those on the nasal tip, may benefit more from radiotherapy than surgical reconstruction.

• Large defects require distant flaps: Extensive defects infiltrating adjacent areas (e.g., the oral cavity) are better suited for reconstruction using distant flaps.

• Poor patient health: Patients with significant comorbidities (e.g., ASA group 3 or 4, severe insulin-dependent diabetes, or heavy smokers) are at a higher risk of complications and may not be suitable candidates for flap surgery.