Nuanced Head and Neck Skin Cancer Reconstruction

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Advanced head & neck skin cancers continue to exact an unacceptable toll in morbidity and mortality in our sun blessed community. Here is a background and example of some cases treated by Mr Farhadieh. The Head & Neck is perhaps the truest art of reconstruction with significant bearing on any facial cosmetic procedures. It is in this most aesthetically sensitive part of our self that all the skill sets and arts of Plastic surgery are utilised to create the best reconstructive and cosmetic outcome.

Perhaps the most enduring art of the plastic surgeon away from SnapChat, Facebook, Instagram and twitter is the provision of nuanced reconstructions in cases of skin cancer. Whilst some these may be extensive and even catastrophic owing to their position patients often seek help in early stages of the disease.

The old plastic surgery adage of “Robbing Paul to Pay Peter” is truest in this terrain. The various components of the face, Nose, Lip, Cheek, Eyelids and Forehead have all been divided into classic aesthetic subunits. These are based on valleys and peaks and the effects of light in projecting shadows and images. The most detailed one being the nasal subunits. The relevance of these is vital not only to reconstructive surgery but also to facial aesthetic surgery.

Where Melanoma is involved often a sentinel node biopsy is part of the management protocol. In principle all reconstructions should seek to “replace like with like tissue”, this is the basic mission the founder of our profession Sir Harold Gillies bequeathed us. There is no skin, which has better quality, consistency, texture and colour than the immediate adjacent surrounding tissues.

Melanoma of Upper Cheek and Lower Eyelid Treated with Sentinel Nodel Biopsy and Large Cheek Rotation Flap

Melanoma of Upper Cheek and Lower Eyelid Treated with Sentinel Nodel Biopsy and Large Cheek Rotation Flap

Excision of a Large SCC from the Right Cheek and Large Cheek Rotation Flap.

Excision of a Large SCC from the Right Cheek and Large Cheek Rotation Flap.

When and where this is not possible then more distal sites may be used. With special areas such as lips, nose, and eyelids the mission remains the same. In reconstructing these sites we may often borrow special tissues from the opposite eyelid or lip. Reconstructing full thickness defects of these sites, includes considerations to be given to mucosa, structural support as well as skin cover reconstruction. The following are examples demonstrating these principles and final results.

Subtotal Lower Lip Reconstruction with 2 Stage Abbe flap, Showing Results Post Adjuvant Radiation Therapy.

Subtotal Lower Lip Reconstruction with 2 Stage Abbe flap, Showing Results Post Adjuvant Radiation Therapy.

Excision of the Left Nasal Ala with 3-Stage Forehead Flap Using Septal Cartilage for Alar Structural Support.

Excision of the Left Nasal Ala with 3-Stage Forehead Flap Using Septal Cartilage for Alar Structural Support.

Total Lower Lid Reconstruction, including Chondromucosal Septal Graft for Tarsal Plate and Mucosal Reconstruction.

Total Lower Lid Reconstruction, including Chondromucosal Septal Graft for Tarsal Plate and Mucosal Reconstruction.

The traditional reconstructive ladder, involves, an escalation from direct closure to, graft or local flap and finally to regional or distal microsurgical reconstruction.

Excision of an Orbitally Invasive SCC Including Exenteration with a Two Stage Scalp Flap.

Excision of an Orbitally Invasive SCC Including Exenteration with a Two Stage Scalp Flap.

Dural, Cranial Vault and Scalp Reconstruction of a Recurrent Invasive SCC with an Anterolateral Thigh (ALT) Free flap.

Dural, Cranial Vault and Scalp Reconstruction of a Recurrent Invasive SCC with an Anterolateral Thigh (ALT) Free flap.

Ross Farhadieh
Mr Farhadieh is an internationally renowned Australian qualified and trained Plastic Surgery. He holds fellowship qualifications in Plastic Surgery from Royal Australian College of Surgeons, Royal College of Surgeons (England) as well the European Board of Plastic Reconstructive Aesthetic Surgery. He has multiple clinical subspecialty fellowships in Cosmetic, Pediatrics as well as Microsurgery from World Leading institutes in London.
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