Reconstruction of composite facial defects: nasal sidewall and medial cheek. The importance of two flaps technique

ABSTRACT Facial skin defects affecting the nasal sidewall and medial cheek entail a reconstructive challenge for the surgeon. They belong to the central third of the face and thus, they have a direct impact on aesthetics. The difficulty in repairing these defects lies in the need to restore facial symmetry and three-dimensionality. In addition, there is a need to preserve the qualities of the skin of each subunit, since they have a different dermal thickness and different number of sebaceous glands. That is the reason why these defects should not be addressed using a single flap and they require a different reconstructive approach. Although composite central facial defects are common, there is not a unified approach to repair them. The cases presented in this manuscript involves patients who underwent surgical intervention to remove a skin cancer. The extirpation resulted in a cutaneous defect affecting both the nasal sidewall and medial cheek. The surgical technique consisted of harvesting two different flaps, obtaining good cosmetic and functional results, and minimizing donor site morbidity.