Objective:To explore the clinical strategy of using adjacent tissue flaps to immediately repair large facial soft tissue defects after resection of lateral facial skin tumors in the elderly patients.Methods:The clinical data of the elderly patients with large soft tissue defects after resection of skin malignant tumors on the lateral facial region from July 2016 to June 2020 were reviewed by the Department of oral and maxillofacial surgery of Qilu Hospital of Shandong University and the Department of Oral and Maxillofacial Surgery of Xinjiang Uygur Autonomous Region People’s Hospital. All the soft tissue defects after tumor resection were larger than 3.0 cm×3.0 cm. The line drawn from the top of the helix to the lateral canthus was used as an anatomical marker. Twelve cases of type Ⅰ defects were located in the lower part, and 12 cases of type Ⅱ defects were located in the upper part. Type Ⅰ could be subdivided into two subclasses: Type Ⅰa, which was mainly located in the aesthetic unit of the buccal area. Submental artery island flap (SMAIF) was used to repair and restore its thickness and convexity. Type Ⅰb, the defects extended directly to the tragus, which was located in the aesthetic regions of the lateral and zygomatic subunits, cervicofacial or cervicothoracic rotation flaps were used to repair thinner tissue defects. For type Ⅱ, defects mainly located in the temporal and forehead regions abovethe dividing line, which were repaired by the cervicothoracic and forehead rotation flaps. Then, visual analogue scale (VAS) was used to evaluate patients’satisfaction about the incision design and aesthetic outcome 3 months after operation.Results:There were 24 patients (15 males and 9 females) included in this study with an average age of 68.6 years (range from 57-86 years) when the disease was at onset, including 69.7 years for males and 66.8 years for females. The average defect area after tumor resection was 37.1 cm 2 (5.0 cm×4.5 cm-8.5 cm ×7.0 cm). Six cases of type Ⅰa defect were repaired with SMAIFs. Three cases of type Ⅰb defect were repaired with the cervicofacial rotation flaps, and the other three cases of type Ⅰb were repaired with cervicothoracic rotation flaps. Twelve cases of type Ⅱ defect were repaired with cervicothoracic and forehead rotation flaps. Visual analogue scale (VAS) score was 9.3 on average (8.9-9.7) at 3 month after operation, and the patients were very satisfied with the incision design and the cosmetic outcome. No recurrences were found in patients with a follow-up period ranged from 10-43 months (average 27.1 months). Conclusions:One or more adjacent tissue flaps can be used for the immediate reconstruction of the lateral facial region soft tissue large defects. The line drawn from the top of the helix to the lateral canthus can be used as an anatomical marker. The selection of these flaps can be planned preoperatively based on the location and size of the defect or lesion. For elderly patients with relatively low malignant skin cancer, using adjacent tissue flaps to repair large lateral facial soft tissue defects could be the preferred treatment.

Objective:To explore the clinical strategy of using adjacent tissue flaps to immediately repair large facial soft tissue defects after resection of lateral facial skin tumors in the elderly patients.Methods:The clinical data of the elderly patients with large soft tissue defects after resection of skin malignant tumors on the lateral facial region from July 2016 to June 2020 were reviewed by the Department of oral and maxillofacial surgery of Qilu Hospital of Shandong University and the Department of Oral and Maxillofacial Surgery of Xinjiang Uygur Autonomous Region People’s Hospital. All the soft tissue defects after tumor resection were larger than 3.0 cm×3.0 cm. The line drawn from the top of the helix to the lateral canthus was used as an anatomical marker. Twelve cases of type Ⅰ defects were located in the lower part, and 12 cases of type Ⅱ defects were located in the upper part. Type Ⅰ could be subdivided into two subclasses: Type Ⅰa, which was mainly located in the aesthetic unit of the buccal area. Submental artery island flap (SMAIF) was used to repair and restore its thickness and convexity. Type Ⅰb, the defects extended directly to the tragus, which was located in the aesthetic regions of the lateral and zygomatic subunits, cervicofacial or cervicothoracic rotation flaps were used to repair thinner tissue defects. For type Ⅱ, defects mainly located in the temporal and forehead regions abovethe dividing line, which were repaired by the cervicothoracic and forehead rotation flaps. Then, visual analogue scale (VAS) was used to evaluate patients’satisfaction about the incision design and aesthetic outcome 3 months after operation.Results:There were 24 patients (15 males and 9 females) included in this study with an average age of 68.6 years (range from 57-86 years) when the disease was at onset, including 69.7 years for males and 66.8 years for females. The average defect area after tumor resection was 37.1 cm 2 (5.0 cm×4.5 cm-8.5 cm ×7.0 cm). Six cases of type Ⅰa defect were repaired with SMAIFs. Three cases of type Ⅰb defect were repaired with the cervicofacial rotation flaps, and the other three cases of type Ⅰb were repaired with cervicothoracic rotation flaps. Twelve cases of type Ⅱ defect were repaired with cervicothoracic and forehead rotation flaps. Visual analogue scale (VAS) score was 9.3 on average (8.9-9.7) at 3 month after operation, and the patients were very satisfied with the incision design and the cosmetic outcome. No recurrences were found in patients with a follow-up period ranged from 10-43 months (average 27.1 months). Conclusions:One or more adjacent tissue flaps can be used for the immediate reconstruction of the lateral facial region soft tissue large defects. The line drawn from the top of the helix to the lateral canthus can be used as an anatomical marker. The selection of these flaps can be planned preoperatively based on the location and size of the defect or lesion. For elderly patients with relatively low malignant skin cancer, using adjacent tissue flaps to repair large lateral facial soft tissue defects could be the preferred treatment.