Some of the more invasive or advanced skin cancers result in defects which may require complex multi-flap reconstructions. A complex defect is determined by size, lack of structural integrity due to missing mucosal lining, cartilage, fat and muscle, or small defects on the nose or eyelid where simple closures will leave aesthetically displeasing results.
Reconstructions of the nose and ear commonly involve using muscle, fat graft, or cartilage from the nose, ear or rib as support structure to adequately fill the defect.
Maintaining aesthetics and function during a reconstruction involves determining what needs to be replaced and if extra skin is needed, where that skin will come from. Moving skin can either come from a single location or multiple adjacent areas to close the defect with minimal tension to avoid distortion.
An island flap is created by using the adjacent healthy tissue to repair a defect. It is the workhorse flap of advanced skin cancer reconstruction. The island flap is usually triangular or a tear-drop shape. Its hallmark is avoidance of additional skin excision and even distribution of repair tension. The island flap uses fewer incisions and creates less scarring than local skin flaps.
A regional flap is similar to an island flap, but is used when a much larger section of tissue is required. Very invasive or advanced skin cancers on the nose can result in deep and large nasal defects. This requires major nasal restoration and several stages to repair. The technique which has been most reliable in this type of repair is the regional flap. All three layers of the nose (the cutaneous outer skin, the structural support, and the inner lining) may need to be replaced. A section of tissue, including the deeper layers, is partially released from either the forehead or the nasolabial area of the cheek while the area proximal (closest) to the defect remains temporarily attached to the body's vascular supply. It is then used to replace the large area of missing tissue while retaining its vital blood supply.