Complex local flap design in cheek reconstruction

Reconstruction of cheek skin and soft tissue defects requires in-depth knowledge of skin and soft tissue mechanics, proper soft tissue handling, and flap geometry and design. In circumstances in which primary repair or secondary intention healing are not appropriate, complex local flaps can allow closure of even very large skin defects. Myriad varieties of local flaps have been described, and each possesses distinct advantages. With an understanding of some basic concepts, the surgeon may approach each cheek defect individually and choose the appropriate reconstruction strategy, while avoiding undesirable outcomes. This article describes the authors' technique for selection and design of complex local flaps in reconstruction of the cheek.